DIAGNOSIS AND TREATMENT OF DIABETIC ANGIO PATHY OF THE LOWER-LIMBS

Experience in the treatment of 77 patients with diabetic angiopathy of the lower limbs is discussed. Various pyonecrotic complications devel oped in 44 % of cases. Laboratory and instrumental diagnostic methods included general clinical, biochemical, and coagulation tests, angiogr aphy, dopplerography, and rheovasography. Rheovasography was elaborate d in 1952 at the Facultative Surgical Clinic headed by N. Elansky and is still an informative method. The management of patients with diabet ic angiopathy included correction of carbohydrate metabolism, angiopro tectors, anticoagulants, and anti-aggregation agents. In patients with pyonecrotic complications intraarterial infusion of the medicinal age nts is preferred, the method is used in the clinic since 1951. Operati ons were performed on 74 % of patients, the character of the intervent ion was determined by the affection of the vascular bed. Reconstructiv e operations were conducted on 16 % of patients. In the absence of con ditions for reconstruction lumbar sympathectomy was undertaken. Accord ing to indications, the operation was combined with necrotomy or ''min or'' amputations. Adequate non-operative therapy, improvement of circu lation in the limb by reconstructive operations or sympathectomy save the limb or limit the volume of the amputation. Amputation through the middle third of the leg was performed in 7, exarticulation at Chopart 's joint in 2 and at Lisfranc's joint in one, and exarticulation of th e toes in 10 patients. No fatal outcomes occurred. The thigh was amput ated in 13 patients with moist gangrene for vital indications, mortali ty was 45 %. Timely recognition of affection of the arteries in diabet es mellitus is recommended for determining the indications for operati ve interventions aimed at preventing pyonecrotic complications.