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Quantitative morphological estimation of surgical treatment of patients with a chronic ischemia of the lower limb with the direct, indirect and composite revascularization

Author(s): Shkuropat V.M. | Tverdokhleb I.V. | Drjuk M.F.

Journal: Морфологія
ISSN 1997-9665

Volume: 2;
Issue: 4;
Start page: 60;
Date: 2008;
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Keywords: ischemia of the lower limb | revascularization | postoperative period | morphology

The purpose of research was the morphological analysis of anterior tibial muscle after direct, indirect and composite revascularization in near-term and long-term postoperative periods. The biopsy material from 144 patients from 25 till 84 years with ІІІ degree ischemia of lower limb as a result of occlusive-stenotic disorders of arteries of femoral-popliteal-tibial segment. Patients have been divided into three groups: 1) 37 patients after femoral-tibial reconstruction; 2) 57 patients after indirect revascularisation with autotransplantation of bone marrow; 3) 50 patients after composite revascularization of distal part of lower limb. The observation was carried out in the near-term postoperative period and in 2 years. Research was carried out in age groups: І - till 34 years; ІІ - 35-59 years; ІІІ - 60-74 years; ІV - 75 years and more. Histological and morphometric study of tissue samplings of anterior tibial muscle taken between superior and middle one thirds was carried out. It have been determined that direct revascularisation causes the significant improvement in morphological parameters of muscular, stromal and microcirculate components of muscle in all age groups during 6 months after operation, however does not provide the stabilization of positive morphological changes in long-term postoperative period. Indirect revascularization does not change significally structurally-functional condition of components of muscle in near-term postoperative period, however causes the stable normalization of parameters of tissue components due to initiation of neovasculogenesis at patients till 75 years. Composite revascularization for these patients allows to receive near-term normalizing effect concerning the studied morphological criteria after operation and to provide its stabilization in the long-term postoperative period.
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