RU1811372C - Method for diagnosis of passability of shin-foot arterial segment - Google Patents

Abstract

Usage: medicine, vascular surgeons. The purpose of the invention is to improve the accuracy of the method. SUMMARY OF THE INVENTION: An orthostatic test is performed with transcutaneous monitoring of blood gases. According to the increase in the partial tension of oxygen in the skin of the foot relative to the bookstatic position, the degree of damage under the knee-tibia-foot segment is judged.

Description

The invention relates to the field of medicine, specifically to vascular surgery, and can be used for preoperative diagnosis of patency of the tibia-stop arterial segment in patients with a multisegmental nature of damage to lower limb arteries.

The aim of the invention is higher. the percentage of coincidence of preoperative diagnosis of patency of the tibia-foot arterial segment in patients with polysegmented lesion of lower limb arteries.

It was noticed that the value of the orthostatic increase in the partial pressure of oxygen, measured on the back of the foot, is different in all patients. Moreover, with a greater difference in pressure in the vertical and horizontal position of the patient, the best results of surgical treatment are observed. In the study of angiograms, it was noted that in patients with occlusions of the aorto-femoral and femoral-popliteal segments, the pressure gradient of the partial tension of oxygen in the vertical and horizontal positions is more dependent on the patency of the tibia-foot arterial segment than on proximal occlusion . This is explained by the fact that when the patient is placed in a vertical position, the blood pressure in the post-occlusive tibial segment (in patients with proximal occlusions) will increase due to collateral connections between the femoral-popliteal and popliteal-tibial segments. It is assumed that during patency of the tibia-stop arterial segment, as well as the plantar arterial arch, this increase in arterial pressure will occur in the arteries of the foot, which will lead to an increase in the partial pressure of oxygen in the distal parts of the foot. When confirming this scientific fact, this test could be used as a non-invasive method for the diagnosis of damage to arteries of the tibia-foot arterial segment. Clinical studies have been conducted

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follow-up, including preoperative transcutaneous measurement of oxygen in horizontal and vertical positions, pre- and intraoperative arteriography, intraoperative vascular revision in patients with polysegmental atherosclerotic occlusions of lower limb arteries, It was found that the difference between the partial pressure of oxygen in the vertical and horizontal position x patient was equal to or more than 20 mm RT. Art. with passable tibia-foot segment. With a difference of less than 20 mm RT. Art. 2 possible lesions were possible.

1. The insufficiency of the collateral connections of the proximal arterial segment (with this type of lesion, the proposed diagnostic method was not informative),

2. Occlusion of the arteries of the tibia-foot segment, As a reliable criterion for differentiation of the last two

-state by experiment, an indicator was found — the ankle-brachial index of regional systolic pressure (PLIRSD) 0.3. With orthostatic pressure increase less than 20 mm RT, Art. and PLIRSD more than 0.3 there was obstruction of the tibia-foot arterial seg. the cop. With orthostatic pressure increase less than 20 mm Hg. Art. and PLIRSD less than 0.3, the technique was uninformative, which required a number of cases of vascular revision and intraoperative arteriography. Subsequent clinical studies confirmed the correctness of the scientific fact, Diagnosis of patency of the tibia arterial segment by the claimed technique in patients with severe lower ischemia limbs are carried out as follows: the patient is placed on a couch and after degreasing the skin with alcohol on the dorsum of the foot in the region of the 1st interdigital space, the sensor is pre-fixed calibrated transcutaneous oxygenometer. After stabilization of the indicators of oxygen tension, the patient is transferred to a vertical position and new indicators of the monitor are recorded within 3-5 minutes. The difference (orthostatic increase) in the oxygen voltage is calculated. With a value of the latter less than 20 mm RT. Art. in the lower third of the lower leg, a tanometer cuff is applied. The ultrasonic flowmeter probe measures blood flow below the cuff on the tibia arteries, followed by measurement of the RSD (regional systolic pressure) on them. Brachial blood pressure is measured by the well-known method, after

which is calculated by PLIRDS (ratio of RSD to shoulder pressure).

Example 1. A patient, 53 years old, was admitted to the hospital with a diagnosis of atherosclerotic occlusion of the femoral-popliteal segment on the right, KHAN 3rd degree. Upon receipt of the right, the lower leg is pale, there is no hair on the foot, and the superficial veins are spasmodic. Pulsaci

is determined on the femoral artery, below none. Patient examined: UZGD-shoulder-ankle index 0.3. In femoral arteriography, there is occlusion of the surfaces of the femoral artery, the posterior tibial artery is contrasted, the anterior tibial artery is significantly affected. Foot arteries are not visualized. Patient performed (transcutaneous monitoring of blood gases of the right foot according to the proposed

methodology. In this case, the oxygen voltage

in a horizontal position 7 mm RT. Art., in

upright position 28 mmHg. Art. (increase of 21 mm RT, Art.). Diagnosed with atherosclerotic occlusion of superficial

femoral artery on the right. KHAN - 3rd degree, tibia-foot arterial segment pass. The patient was operated on - a femoral-popliteal autogenous bypass grafting was performed. AT

postoperative regression of ischemia, the ankle-brachial index increased to 1.0. The patient was discharged in satisfactory condition for outpatient treatment. When viewed after 3 months. state

satisfactory patient, no complaints, no limb ischemia. A clear pulse on the tibial artery is detected.

Example 2. Patient 55 years old, was admitted

to the clinic with a diagnosis of atherosclerotic occlusion of the femoral-popliteal segment on the right, chronic arterial insufficiency of the 3rd degree. Upon receipt of a complaint of pain in the right lower limb when walking and at rest, numbness of the foot. He considers himself to be sick within six months, when these symptoms appeared. Previously, the patient had amputation of the left lower limb due to obliterating atherosclerosis, gangrene of the foot. On admission: the right foot is cool, the superficial veins are spasmodic, and there is no hairline on the foot. The patient was examined: UZGD - 0.42 shoulder-ankle index (blood flow. It is located on the tibial artery). Femoral arteriography: there is occlusion of the superficial femoral artery, the deep femoral artery is passable,

the posterior tibial artery is passable, the perineal tibial artery is occluded. Foot arteries are not visualized. The patient was monitored for blood gases by the proposed method: When measuring blood gases in a horizontal position, the oxygen pressure on the foot was 3 mm Hg. Art., in the vertical - 15 mm RT. Art., thus an increase of 12 mm RT. Art. Diagnosed with atherosclerotic occlusion of the superficial femoral artery, occlusion of the arteries of the tibia-foot segment, KHAN 3rd degree. Taking into account pronounced ischemia of the limb, ineffectiveness of conservative therapy, the patient was operated on - a femoral-popliteal autovenous bypass grafting was performed. 15 hours after surgery, thrombosis of the autogenous shunt occurred. Due to progressive ischemia. And a month after surgery, the patient was amputated limbs. In the study of the drug, it was found that there is occlusion of the tibial artery on the foot and occlusion of the anterior tibial artery along, i.e., the distal vascular bed is unsatisfactory.

The proposed method for diagnosing patency of the tibia-foot arterial segment has no contraindications, is non-invasive and can help to obtain information where other diagnostic methods are not informative. Thus, aortography or femoral arteriography in patients with severe ischemia of the lower extremities, due to the multistory artery lesions, does not always lead to contrasting of the steel channel and the invasive method. Intraoperative arteriography is preferable, but it, as the main diagnostic method, cannot be used, as this will lead to an unreasonably large number of intraoperative vascular revisions.

Claims (1)

According to published data, the informational content of ultrasonic vascular examination methods for diagnosing lesions of the tibia-foot arterial segment does not exceed 77%. All 23% of error cases are associated with false positive data. The inventive diagnostic method gave the correct information, confirmed angiographically and intraoperatively in 93% (16% more informative when compared with the base object). The method is not complicated, not invasive, and can be used at the prehospital stage for the correct selection of patients for surgery or conservative treatment. The proposed method does not have a significant drawback of the prototype - to influence the results of the study of possible patient hypoxia, as well as the partial oxygen voltage of atmospheric air, because it is not the absolute values of the oxygen voltage that are used, but its gradient. SUMMARY OF THE INVENTION A method for diagnosing patency of the tibia-stop arterial segment, comprising measuring the partial oxygen tension in the patient’s foot with a half-segmented lesion of the lower limb arteries, characterized in that, in order to increase the accuracy of the method, the oxygen pressure in the foot is measured in horizontal and the vertical position of the patient, then the difference is calculated and at a value of more than 20 mmHg. Art. diagnose patency, and with a difference of less than 20 mm RT. Art. additionally, the shoulder-ankle index of the region is determined. Different systolic pressure and, with its value of more than 0.3, the occlusion of the arteries of the tibia-foot segment is diagnosed.