Abstract

We performed an analysis of literature data about angiosome concept in treatment of patients wih critical lower limb ishemia. We presented data on the appearance and development of this concept. Possibilities of using this tactic in various situations are considered, advantages and disadvantages of this concept are shown. Factors, limiting the effectiveness of this method, and alternative methods when it is impossible to restore blood flow according to the angiosome concept - the degree of lesion of arteries and the development of collateral blood flow to restore perfusion of soft tissues are given. It has been shown that the correct assessment of collateral arteries in critical lower limb ischemia plays a central role in any type of lower limb revascularization, and this statement also applies to a strategy based on the angiosome concept.

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Abstract:

Persistent sciatic artery (SA) is recognized as a minority variant of embryogenesis of lower limb artery. Article describes a clinical case of complex treatment of a patient with persistent SA, critical ischemia of lower limb and with diabetic foot. The patient underwent diagnostics of lesion, that helped to find out possible ways of disease progression, endovascular revascularization and step-by-step surgery treatment that allowed to keep support function of the limb.

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Abstract:

Purpose. Was to estimate the informative value of scintigraphy (SG) with labeled leukocytes (LL) in detection of osteomyelitis in patients with various forms of diabetic foot syndrome (DFS)

Materials and methods. This study includes results of scintigraphy with labeled leukocytes of 39 patients with diabetes mellitus and with suspicion of osteomyelitis in diabetic foot. Results were compared with morphological study in 22 patients

Results. SG with LL has high informative value rate in diagnostics of inflammatory process: sensitivity - 100%, specificity - 100% accuracy - 100%; and also high in the diagnostics of osteomyelitis: sensitivity - 100%, specificity - 64,7%, accuracy - 84,6%.

Conclusions. LL CG is a highly effective method of identifying the presence of an inflammatory process. During high rate of sensitivity the level of specificity decreases in case of intraosseous inflammation. The reason of decreased specifity is in that SG has low resolution in differentiation of radiopharmaceutical accumulation in bones and soft tissues.

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Abstract:

Purpose. Was to еstablish the informative value of 3-phase scintigraphy in assessment of blood flow and identify pyo-inflammatory process in patients with neuropathic, ischemic, and mixed forms of diabetic foot.

Materials and methods. This study includes the results of three-phase scintigraphy of 76 patients with diabetes mellitus and with suspicion of osteomyelitis in diabetic foot. Results were verified with morphological study in 39 patients.

Results. In patients with diabetic foot the depression of the main vessels blood flow and blood flow prevalence the changes intraosseous blood flow. Three-phase scintigraphy revealed a lower specificity (66,7%) in the diagnosis of osteomyelitis in patients with diabetes mellitus at the sensitivity (94,7%) and accuracy (73,7%).

Conclusions. Three-phase scintigraphy is high-performance method in revealing the arterial and peripheral blood flow disorder in patients with diabetes mellitus. The low specificity of the three-phase scintigraphy with high sensitivity indicates the limited possibilities of the method in the identification of pyo-inflammatory process in patients with diabetes mellitus. The observed preservation of blood flow makes it possible to expand indications of methods of nuclear medicines and applies scintigraphy with labeled leukocytes for indication purulent infection in patients with complicated course. 

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Abstract:

Aim: was to evaluate pedal vascularisation in diabetic patients with using contrast MR-angiography.

Material and methods: 23 patients (15 male, 8 female; mean age 56±14,6) with suspicion on osteomyelitis (OM) underwent MR-angiography (Gadobutrol 15ml). Imaging analysis included blood-flow's speed, vascular architectonic's condition and character of contrast's accumulation, microcirculation was especially estimated. Results were compared with white blood cells-scan in identification of pyoinflamation. Osteomyelitis was verified according to operations in all cases.

Results: all patients were divided in 3 groups: neuropathic (n=9; 39,0%), neuroischemic (n=10; 43,5%), ischemic (n=4; 17,5%) forms of diabetic foot. First-pass MR-angiography detected significant delay in contrast's arrival in ischemic group. There were no significant differences between values of neuropathic and neuroischemic forms of diabetic foot. There were no pedal vessels in patients in ischemic and neuroischemic groups. Contrast MR-angiography revealed three types of contrast distribution in soft tissues: uniform, local increase and local absence. Osteomyelitis was characterized as diffuse enhanced contrast accumulation in all cases.

Conclusions: MRI blood vessel imaging is a promising and valuable method for examining peripheral arterial changes in diabetic foot and may be useful for treatment planning in different forms of diabetic foot. 

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