Purpose of the study. To study the quantitative indicators of microcirculation and perfusion of the skin of the lower extremities, taking into account the angiosomal theory. Materials and methods. We studied the microcirculation of the skin of the lower extremities in 31 people, taking into account the angiosomal approach without pathology of the cardiovascular system on the device Easy-LDI company AIMAGO SA (Switzerland). Results. We found that the highest rates of perfusion units on the thigh were found in the pool of the sciatic and posterior arteries, the lowest – in the pool of the deep femoral artery and popliteal artery. On the shin, the highest rates of microcirculation are found in the pool of the posterior tibial artery, the lowest – on the foot. Having such an objective quantitative perfusion index, it is easy to determine the occlusion of the arteries corresponding to the angiosomes, areas of the skin of the lower extremity and to quantify the results of the treatment. Conclusions. The developed indicators of skin perfusion of angiosomes of the lower extremities can normally form the basis for diagnosing the degree of stenosis of the main arteries, serve as an indication for direct and indirect methods of revascularization in obliterating diseases of the arteries of the lower extremities and quantify immediate and long-term treatment. Keywords: Angiosomal theory, transcutaneous oxygen tension, regional perfusion index, skin microcirculation, revascularization

Цель. Оценить эффективность непрямых способов реваскуляризации при хронической ишемии нижних конечностей в улучшении коллатерального кровообращения согласно ангиосомной теории.Материалы и методы. Нами проведен анализ лечения 93 пациентов в отделении сосудистой хирургии ЗОКБ им. Андрея Новака, г. Ужгород, с 2015 по 2019 год с диагнозом «облитерирующий атеросклероз сосудов нижних конечностей».Все пациенты имели бедренно-берцово-стопное атеросклеротическое поражение магистральных артерий с сохраненным центральным кровотоком в аорто-подвздошном сегменте. Результаты. МСКТ, ангиографический и доплеровский анализ позволили нам выделить несколько типов поражения артерий дистального русла.Нами было установлено, что после изолированной профундопластики конечности транскутанное напряжение кислорода (ТНК) в тканях голени и стопы увеличилось, но при этом наименьшее увеличение напряжения кислорода наблюдалось на тыле стопы.При профундопластике + РОТ (роторная остеотрепанация) также отмечалось увеличение транскутанного напряжения кислорода практически во всех точках измерений, где напряжение кислорода в бассейне задней большеберцовой артерии (ЗББА) было максимальным, в то же время при роторной остеоперфорации наблюдалось только незначительное увеличение напряжения кислорода в бассейне передней большеберцовой артерии (ПББА), ангиосомах тыла стопы и подошвы.Все неудовлетворительные результаты наблюдались при величине ГБПИ >0,37.Выводы. 1. Количество удовлетворительных результатов в отдаленном периоде наблюдалось у 94,6% пациентов с профундопластикой + РОТ, у 87% – при изолированной профундопластике, у 57,9% пациентов – при РОТ. 2. Транскутанное напряжение кислорода после изолированной профундопластики, профундопластики + РОТ наибольшее в ангиосоме бассейна ЗББА.3. При выполнении РОТ транскутанное напряжение кислорода увеличилось на 10% в бассейне ПББА на подошве и тыле стопы. Purpose. To evaluate the effectiveness of indirect revascularization methods in chronic ischemia of the lower extremities in improving collateral circulation, according to the angiosomal theory.Materials and methods. We analysed the treatment of 93 patients at the Department of Vascular Surgery named after Andrey Novak, Uzhgorod, from 2015 to 2019 with the diagnosis of obliterating atherosclerosis of the vessels of the lower extremities.All patients had femoral-tibial-foot atherosclerotic lesions of the main arteries with preserved central blood flow in the aorto-iliac segment.Results. MSCT, angiographic and Doppler analyses allowed us to identify several types of damage to the distal arteries.We found that after indirect revascularization of the limb, the oxygen tension in the tissues of the leg and foot is increased, but the smallest increase of oxygen tension was observed on the dorsum of the foot.During profundoplasty + ROT, the increase of oxygen tension was also noted at almost all measurement points, where the oxygen tension in the ZBBA basin was the maximum. At the same time, in rotary osteoperforation, only a slight increase of oxygen tension in the PBBA basin, angiosomes of the dorsum of the foot and sole was observed.All unsatisfactory results were observed in the GBPI value> 0.37.Conclusions. 1. The number of satisfactory long-term results was observed in 94.6% of patients with profundoplasty + ROT, in 87% of patients – in isolated profundoplasty, in 57.9% of patients – in ROT. 2. Transcutaneous oxygen tension after isolated profundoplasty, profundoplasty + ROT is the highest in the angiosome of the ZBBA basin. 3. When performing ROT, the transcutaneous oxygen tension increased by 10% in the PBBA pool on the sole and back of the foot.

The aim: To assess the immediate results of autovenous femoral-tibial shunting in combination with rotary osteotrepanation of the tibia by studying changes in the transcutaneous ptO2 tension in the tibia and foot tissues depending on the revascularization of the tibial arteries. Materials and methods: We analyzed the treatment of 69 patients with obliterating atherosclerosis of the vessels of the lower extremities. According to the degree of ischemia of the lower extremities, the patients were distributed as follows: III A degree of ischemia - 20 (29%), III B - 28 (40.6%), IV - 21 (30.4%) patients. All patients had atherosclerotic lesions of the popliteal-tibial segment of the great arteries with preserved central blood flow in the aorto-iliac segment. Results: Occlusion of the anterior tibial artery was recorded significantly more often than the peroneal artery (72% and 42%, respectively, p = 0.05), but with the same frequency compared to the posterior tibial artery (68%, p = 0.61). The lesion of two or three arteries of the lower leg was recorded more often than occlusion of one (n = 51; 73.9% and n = 18; 26.1%). Occlusive-stenotic lesion of the popliteal artery was observed in 54 (78.2%) patients. The highest incidence of lesions of the tibial arteries was observed in the basin of the anterior tibial artery in 28 (40.6%) patients. Combined lesions of the anterior tibial artery and posterior tibial artery were diagnosed in 19 (27.5%) patients. Limited lesions of the posterior tibial artery were found in 15 (21.7%) patients. The combination of lesions of the posterior tibial artery and peroneal artery was diagnosed in 7 (10.2%) patients. Conclusions: 1. The patency of the femoral-tibial autovenous shunt during the year was 71%. High limb amputation was performed in 29% of patients. 2. According to CT data, the localization of trophic changes on the foot during critical ischemia of the lower extremities corresponds to the affected segment of the arterial angiosome, which supplies the corresponding area with blood. 3. After femoral-tibial autovenous bypass grafting, the highest levels of transcutaneous oxygen tension were observed in the basin of the posterior tibial artery and peroneal artery, and the lowest indicators of transcutaneous oxygen tension were observed in the basin of the anterior tibial artery. 4. During femoral-tibial autovenous shunting operations in combination with rotary osteotrepanation, the transcutaneous oxygen tension indices increased threefold in the angiosomal basin of the posterior tibial artery and peroneal artery, and twofold in the angiosomes of the dorsum of the foot and sole.

Objective. To optimize the tactics of surgical treatment in patients, suffering chronic ischemia of the lower extremities with the help of elaboration and introduction of a one-staged direct and indirect revascularization into clinical practice. Materials and methods. Analysis of the treatment results in 162 patients, suffering obliterating atherosclerosis of the lower extremities vessels, who were treated in stationary in Department of Vascular Surgery of Zakarpattya Regional Clinical Hospital named after Andriy Novak in 2015 - 2020 yrs. The patients were distributed in accordance to the lower extremities ischemia degree: ІІB – 7 (4.3%), ІІІA – 61 (37.7%), ІІІB – 58 (35.8%), ІV – 36 (22.2%). All the patients have had atherosclerotic affection of femoro-ankle-foot segment of the main arteries with preservation of central blood flow in aorto-iliac segment. Results. Occlusion of femoral artery was noted in all patients. Occlusion of anterior tibial artery was revealed most frequently – in 72% of the patients, than in fibular - in 42% of patients (p=0.00), and equally frequently with occlusion of posterior tibial artery – in 68% (p=0.61). The foot arteries were involved into the process in 51 (31.5%) patients. Affection of 2-3 arteries of the shin were registered more frequently, than occlusion of one artery – in 109 (67.3%) and 48 (26.5%) patients, accordingly. Occlusive-stenotic affection of popliteal artery have had 127 (78.4%) patients. Mostly frequent affection of the shin arteries was observed in basin of anterior tibial artery – in 67 (41.4%) patients, as well as in combined affection of anterior and posterior tibial arteries - in 45 (27.8%) patients. Іsolated affection of posterior artery was revealed in 36 (22.2%) patients. Combined affection of posterior tibial and fibular was observed in 14 (8.6%) patients. Conclusion. Efficacy of indirect revascularization after the arterial inflow restoration is more prognosticated, than efficacy of its isolated conduction in environment of chronic critical ischemia of the lower extremities. Combined application of direct and indirect revascularization guarantees more secure positive result in remote postoperative period and enhancement of the extremities preservation index.

Summary. The aim of the study. To study the effectiveness of the proposed surgical methods in the treatment of critical ischemia of the lower extremities. Materials and methods. In our work the analysis of results of treatment of 36 patients with chronic critical ischemia of the lower extremities who were on treatment in ZOKL of them is presented. Andriy Novak. Grade III A ischemia was diagnosed in 11 patients, grade III B — in 15, grade IV — in 10 patients and studied the microcirculation of the lower extremities in 31 people without pathology of the cardiovascular system, taking into account the angiosomal approach. We found that the highest rates of perfusion units on the thigh were found in the basin of the sciatic and posterior arteries, the lowest — in the basin of the deep femoral artery and popliteal artery. On the shin, the highest rates of microcirculation were found in the basin of the posterior tibial artery, the lowest - on the foot. Results and discussion. The level of regional perfusion of the corresponding angiosomes of the skin of the lower extremities after anastomosis between the anterior tibial artery and anterior tibial vein showed that the improvement of microcirculation is observed in those angiosomes whose blood supply is provided by the anterior tibial artery and its artery and artery. When creating anastomoses between the posterior tibial artery and the posterior tibial vein, the microcirculation in the skin increased 3-5 times compared to baseline and its level was 70 % of normal in those angiosomes, which supply blood to the posterior tibial artery and its continuation on the foot. At the same time, there is an increase in skin microcirculation in the angiosome of the tibial artery, which is apparently due to the presence of a relatively large number of first-type anastomoses in the triceps. In our opinion, any of the proposed treatments should begin before the development of critical ischemia. Conclusions. The dependence of skin perfusion on the main arterial blood flow is proved taking into account the angiosomal theory, which allows to use this method in the diagnosis and evaluation of the results of treatment of chronic critical ischemia of the lower extremities. Microcirculation of the skin of the lower leg and foot improves 3.5–5 times 30 days after the creation of arteriovenous fistula below the occlusion of the anterior tibial artery and posterior tibial artery in chronic critical ischemia of the lower extremities.