Treatment of gangrene abroad

Treatment of gangrene: how to save a leg from amputation?

Despite the tremendous progress of modern medicine, there are still diseases that are not easy to cope with. In particular, such a problem is the restoration of impaired blood circulation in the vessels of the lower extremities in patients at risk. One of the best recognized results of Israeli vascular surgeons in restoring the patency of arteries with the help of various types of endovascular interventions. Removal of an atherosclerotic plaque or creation of a lumen in a vessel “de novo” - bypassing an obstacle - allows patients to avoid amputation of a limb.

Ischemia - the path to gangrene

Occlusion or blockage of an arterial vessel leads to the development of ischemia, a condition in which gross metabolic disorders in tissues and oxygen deficiency develop due to insufficient local blood circulation. Such a condition is not indifferent for organs and tissues, and depending on the rate of ischemia development, as well as the degree of its severity, leads to the development of certain symptomatology. In surgery, there is a term denoting the extreme degree of arterial blood circulation disturbance in tissues - the so-called critical ischemia. If blood circulation is not restored as soon as possible, irreversible changes may develop in the tissues, namely gangrene. Unfortunately, reversing the events after the development of gangrene is practically impossible. The only way to solve this problem, as a rule, is the amputation of the limb. Therefore, it is extremely important to help a person in time and restore blood circulation at the stage of initial or critical ischemia.

Gangrene. How to recognize the threat in time?

Gangrene is a severe deep tissue lesion, in which necrosis (necrosis) affects all layers of the organ or limb. Among the causes of the development of gangrene there are many factors: infection, massive tissue damage, but in the first place is a violation of the arterial blood supply. There is a category of patients in whom diseases of the vessels of the arterial bed develop more often and all processes are more aggressive. This group includes people with type 1 and type 2 diabetes mellitus, patients with lipid metabolism disorders and a tendency to hypercholesterolemia, smokers, and people who have had a stroke.

The external signs of gangrene are very characteristic and difficult to confuse with another disease. Soft tissues acquire a typical grayish-black color, become depending on the type of gangrene either dense - string-like, or - edematous, releasing a secretion with a sharp unpleasant odor. However, these are extreme manifestations of vascular catastrophe. It is much more important to recognize the threat of gangrene - critical ischemia. SOS signal from tissues experiencing severe hypoxia are symptoms such as: severe pain in the limb, more pronounced at night, pallor of the skin, dry skin, impaired sensation in the ischemia zone, decreased pulsation in the vessels of the limb, etc. Already at this stage, the patient requires the assistance of a vascular surgeon.

Saving a leg from amputation: treatment options

A patient from the risk group, who is under the supervision of a doctor, for a certain period of time receives drug treatment aimed at improving blood circulation in the ischemic zone. However, in most cases, ischemia progresses, and the medication ceases to help. In such a situation, vascular surgeons come to the rescue with surgical methods of treatment. Most often, the direct cause of occlusion of the vessel is atherosclerotic masses that fulfill its lumen. At the beginning of the disease, the lumen of the vessel is narrowed slightly, but over time the atherosclerotic plaque grows both in the longitudinal and transverse direction of the vessel, up to complete occlusion.

Currently, there are various techniques of endovascular interventions to restore the lumen of an arterial vessel. These include stent placement (“tube” which is placed in the inner lumen of the vessel, through the atherosclerotic plaque, pushing it to the periphery), Silverhawk method (a device-manipulator with a special blade cuts the plaque and removes it from the lumen of the vessel), various variants of bypass operations. All techniques are effective and all have certain indications for their choice. However, in most cases, these techniques can solve the problem of limited extent of occlusion of the vessel. A truly revolutionary method that allows to restore blood flow through an obstruction of more than 20 cm in length has become a truly revolutionary one. Subintimal angioplasty is an intravascular operation, the essence of which is to create a “new” vascular lumen by dissecting its wall. The inner shell of the vessel - the intima, along with atherosclerotic masses, is peeled off with a special guide and moved aside by a dilated balloon. Israeli surgeons successfully performed the operation on vessels with obliteration zone of 40-60 cm. The advantages of subintimal angioplasty are also the absence of the need for anesthesia (the operation is performed under local anesthesia), the possibility of repeated intervention if necessary, low risk of complications and good therapeutic effect.

Treatment of foot gangrene, diabetic foot, lower limb ischemia in Israel

The presumptive plan of outpatient examination:
1.Doppler of leg vessels.
2.Computed tomography of angio vessels of the legs.
3.Laboratory tests as directed by the physician.
4.Consultation of endovascular vascular surgeon.

The cost of this examination depends on the scope of diagnostic measures.
Possible treatment - endovascular revascularization of the vessels of the lower extremities.

Methods of stenting, subintimal angioplasty, SilverHawk razor-knife, etc. are used.