Prolonged intraarterial catheter therapy for diabetic gangrene of the lower limb

Author(s):
Alisher Okhunov; Fayzrakhmon Abduralhmanov

Background:

Diabetic gangrene of the lower extremities is one of the most common causes of death in intensive care units. Although understanding of its pathogenesis has improved, this has not affected the management of these patients.

Hypothesis:

To improve the results of treatment of patients with diabetic gangrene of the lower extremities by developing a pathogen-based regimen of long-term intra-arterial catheter therapy (PIACT).

Methods:

The results of treatment and examination of 267 patients with diabetic gangrene of the lower extremities were analyzed. All patients underwent early surgical intervention with the use of vacuum therapy in the postoperative period, and complex drug therapy was prescribed. After the operation, the catheter was placed into the arterial bed of the affected limb using PIACT. The composition of the administered infusion in patients of group I (control – 126 patients) included drugs whose action was aimed at relieving spasm and intoxication, improving the rheological properties of blood and microcirculation, as well as broad-spectrum antibiotics. Patients of group II (basic – 141 patients) were added glucocorticoids in doses of 60-180 mg/day and albumin, 100-200 ml of 10% solution.

Results:

Persistence in group I of a high proportion of complications associated with sepsis (22.3%) and mortality (4%) indicates the need to revise the traditional PIACT regimens, taking into account the phases of the course of inflammation. The proposed pathogenically substantiated PIACT regimen with the jet administration of antibiotics and albumin at the early stages of treatment (24–48 hours) and the addition of a prednisolone solution to the infusion composition for 2–5 days makes it possible to regulate the course of the inflammatory process with the relief of exudation and tissue edema in the affected area.

Conclusions:

The inclusion of the improved PIACT scheme in the complex of therapeutic measures in the treatment of severe pyoinflammatory diseases made it possible to reduce the incidence of complications to 2.8%, mortality to 1.45% and reduce the duration of treatment from 30.1±0.6 days to 11.8±0 ,6 days.