RU2392948C1 - Method of treating chronic obliterating diseases of lower extremity arteries - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to vascular surgery, and can be used in treating chronic obliterating diseases of lower extremity arteries. That is ensured by introduction of thrombocyte-enriched autoplasma containing polypeptide growth factors into an involved extremity. Said introduction is ultrasound aided from two points in inguinal and popliteal regions in amount 100 ml for each with distributing along the deep artery of thigh and popliteal artery and in adjacent muscles.

EFFECT: method allows stimulating development of collateral blood flow in an ischemic limb and improving arterial inflow from proximal to distal regions.

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Description

The invention relates to medicine, namely to vascular surgery, and can be used in the treatment of chronic obliterating diseases of lower limb arteries.

There is a method of treating obliterating diseases of the arteries of the lower extremities by interstitial and fan-shaped injection of autoplasma enriched with platelets into the soft tissues of the lower leg and foot of an ischemic limb (Dragunov A.G., Katanov E.S., RF patent No. 2319492 IPC A61K 35/14, A61P 9/14). The main disadvantages of this method are:

1) the absence of the stimulating effect of the polypeptide growth factors contained in the blood product on the development of collaterals located along the deep femoral and popliteal arteries, which are the main way to ensure the delivery of oxygen and nutrients to the tissues during occlusion of the femoral artery;

2) the introduction of autoplasma enriched with platelets into the ischemic tissues of the distal extremities, against the background of a reduction in the microrunus and without sufficient collateral blood flow at the level of the femoral and popliteal arteries, does not level critical limb ischemia, but even exacerbates it by increasing interstitial pressure.

The objective of the invention is to stimulate the development of collateral blood flow in the ischemic limb and thus improve the arterial flow from the proximal extremities to the distal.

The task is achieved by the fact that in patients suffering from atherosclerosis obliterans of the vessels of the lower extremities, under ultrasonic control, autoplasma enriched with platelets is introduced along the deep femoral and popliteal arteries.

Platelet-rich plasma is a source of polypeptide growth factors and stimulates the development of arterial collaterals.

The method is as follows.

Under aseptic dressing conditions, a patient receives 500.0 blood from the ulnar vein in special “Gemokon” containers intended for blood donation. Then the blood is centrifuged at a speed of 2.5 thousand revolutions per minute for 15 minutes, as a result of this, an autoplasma enriched with platelets containing a large number of polypeptide growth factors is obtained, which is collected in 50 ml disposable syringes. After the manipulation, the patient is transported to an ultrasound room on a wheelchair, laid on his back. Processing the inguinal region on the side of the affected limb twice 70%

a solution of alcohol, surrounded with sterile material, then the ultrasound probe locate the common and deep femoral artery. An anesthetic (0.5% -10.0 novocaine solution) is injected into the skin and deeper tissues of the inguinal region along the artery. A needle with a syringe with a pre-set autoplasm is taken and, under ultrasound control, it is advanced along the deep femoral artery, distributing the autoplasma in adjacent muscles and creating an autoplasmoinfiltrate around it with a high content of polypeptide growth factors that stimulate neovasculogenesis and the development of collaterals. 100 ml autoplasma is injected from one point. Apply an aseptic dressing. Then the patient is turned on his stomach, the popliteal region on the side of the affected limb is treated twice with a 70% alcohol solution, surrounded with sterile material. After that, the popliteal artery is located with an ultrasonic sensor. Anesthetic (0.5% -10.0 novocaine solution) is injected into the skin and deeper tissues of the popliteal region along the artery. A needle with a syringe with a pre-set autoplasma is taken and, under ultrasound control, it is advanced along the popliteal artery, distributing the autoplasma around it in the soft tissues, also creating autoplasmoinfiltrate from another point with a volume of 100 ml. Apply an aseptic dressing. The patient is transported to the ward.

The invention is illustrated by the following example.

Example. Patient N. Case history No. 6494.

Age 62 years old

Hospitalized in the Department of Vascular Surgery, Municipal Clinical Hospital GKB SMP 05/19/2008; discharged: 2.06.08.

Diagnosis: primary. Obliterating atherosclerosis of the vessels of the lower extremities. Ischemia of the right lower limb II degree, left - III degree.

From the anamnesis it was found that in 2006 the patient underwent femoral-popliteal shunting of the right lower limb and Dietz operation on the right.

Complaints upon admission showed pain in the left lower limb at rest, paresthesia and numbness of the fingers of the left foot. Pain in the right lower limb did not bother.

Objectively: from the side of internal organs pathology is not revealed. Local status: the lower extremities are not swollen, the skin of the left lower limb is pale in color, the hairline is reduced, the nail plates are thickened, not deformed. There are no trophic disorders. The left foot on palpation is cool. Typical postoperative scars from undergoing femoral-popliteal bypass surgery and Dietz surgery on the right. The symptom of Leniel-Lavastin (white spot) on the left is up to 5 seconds, on the right - up to 3 seconds. Pulsation on the left is determined only in the groin, on the right to the popliteal artery.

Instrumental research methods:

- Reovasography from 05/19/08, reovasographic index, cu: left lower leg 0.50; left foot - 0.44 - pulse blood flow on the left lower leg and foot in the stage of decompensation, on the right lower leg and foot in the stage of subcompensation.

- Dopplerography from 05/21/08, the ankle-brachial index - on the left - 0.5, on the right - within normal limits.

- Ultrasound examination of the arteries of the lower extremities from 05.21.08. Conclusion On the right, the shunt is passable, the superficial femoral artery is occluded, the popliteal artery is passable, the blood flow is changed to the main, the posterior tibial artery is not visualized. On the left, the superficial femoral artery is occluded, the deep femoral artery is passable, the main type of blood flow, the popliteal artery: restoration of blood flow in 1 segment, small atherosclerotic changes, the posterior-tibial artery is not visualized.

Conducted standard conservative therapy, which was ineffective. The patient was offered surgical treatment, which he categorically refused.

05/27/08, a minimally invasive intervention was performed under ultrasound control: autoplasma infiltrate of the left lower limb according to the proposed method.

Under aseptic dressing conditions, a patient received 500.0 blood from the ulnar vein in a special Gemokon container. Then the blood is centrifuged at a speed of 2.5 thousand rpm for 15 minutes, as a result of this, an autoplasma enriched with platelets containing a large number of polypeptide growth factors, which is collected in 50 ml disposable syringes, is obtained. After the manipulation, the patient was transported to an ultrasound room on a wheelchair, laid on his back. The left inguinal region was treated twice with 70% alcohol solution, lined with sterile material, then the general and deep femoral artery were located with an ultrasonic sensor. An anesthetic (0.5% -10.0 novocaine solution) was introduced into the skin and deeper lying tissues of the left inguinal region along the artery. Under ultrasound control, a needle with a syringe with pre-set autoplasma is advanced along the deep femoral artery, autoplasma is distributed in adjacent muscles and around the artery, autoplasma infiltrate is created with a high content of polypeptide growth factors that stimulate neovasculogenesis and the development of collaterals. 100 ml autoplasma was introduced from one point. An aseptic dressing is applied. Then the patient was laid on his stomach, the left popliteal area was treated twice with 70% alcohol solution, and lined with sterile material. The popliteal artery is located. An anesthetic (0.5% -10.0 novocaine solution) was introduced into the skin and deeper tissues of the left popliteal area along the artery. A needle with a syringe with a pre-set autoplasma was taken and advanced along the popliteal artery under ultrasound control, the autoplasma was distributed around it in the soft tissues, and autoplasmoinfiltrate was created from another point with a volume of 100 ml. An aseptic dressing is applied. The patient is transported to the ward.

The day after the operation, only slight pain was noted at the injection sites, redness of the skin, and edema was not determined.

The patient was examined after 6 months. Upon admission, he complained of pain in the left lower limb when traveling to a distance of 300-400 m, pain was not disturbed at rest. Instrumental research methods have been completed:

1. Rheovasography: rheovasographic index, cu: left lower leg 0.60; left foot - 0.54.

2. Dopplerography: ankle-brachial index - 0.6 on the left.

Positive dynamics was noted: an increase in rheovasographic and ankle-brachial indices by 0.1.

In the indicated manner, with informed consent, 10 patients with atherosclerosis obliterans of lower limb arteries with positive effect were treated.

Thus, the results of a clinical study indicate that the proposed method is quite effective not only in chronic lower limb ischemia of the II degree, but also in the development of chronic critical ischemia of the III degree.

The advantage of this method is ease of use, which allows it to be used not only in specialized vascular departments, but also in general surgery. Therefore, the proposed method can improve the results of treatment of chronic obliterating diseases of the arteries of the lower extremities.

Claims (1)

A method of treating chronic obliterating diseases of lower limb arteries, characterized in that the platelet-rich autoplasma containing polypeptide growth factors is introduced into the affected limb under ultrasound guidance from two points in the inguinal and popliteal regions in a volume of 100 ml each, distributing it along the deep the femoral and popliteal arteries and in adjacent muscles, thus creating autoplasmoinfiltrate with a high content of polypeptide growth factors directly in the anatomical zones the passage of arterial collaterals.