Acute lower limb ischemia (ALLI) is a limb threatening condition with high risk of adverse outcomes. The timely and proper diagnosis of the severity of limb ischemia is crucial in selecting the optimal treatment method.AIM OF STUDY To evaluate the advantages of hybrid imaging in diagnosis of ALLI, patient selection and its severity in order to choose an optimal revascularization method.MATERIAL AND METHODS we examined 163 patients with grade 1–3A ALLI based on I.I. Zatevakhin et al. classification (2002) on a Discovery 670 NM/CT hybrid device, using X-ray (computed tomographic angiography) and radionuclide method (three-phase scintigraphy/single photon emission computed tomography with osteotropic or perfused radiopharmaceutical).RESULTS CT angiography accurately showed level of acute occlusion as well as distal arterial blood flow in all ALLI cases, thus allowing optimal choice of possible revascularization. CT angiography findings alone did not allow optimal staging of ALLI, which is essential for choosing an optimal revascularization method and were considered as supplementary. Three-phase scintigraphy allowed to differentiate the degrees of ALLI based on the visual picture and calculated data, while studies with osteotropic radiopharmaceutical 99mТс-PYP provided information on viability of affected tissues showing the areas of muscle necrosis, compared to perfused radiopharmaceutical.CONCLUSION 1. CT angiography makes it possible to assess in detail the level and severity of occlusive lesions of the arterial system and study the vascular anatomy of the lower limb to resolve the issue of the possibility of revascularization, and also indirectly characterizes the presence of ischemic changes in soft tissues. 2. The radionuclide method (three-phase scintigraphy with an osteotropic radiopharmaceutical/single photon emission computed tomography), performed in addition to computed tomographic angiography, allows not only to detect the presence of ischemic changes in soft tissues, but also to differentiate the degree of acute ischemia of the lower. 3. The hybrid method (three-phase scintigraphy in combination with computed tomographic angiography) contributes to an objective assessment of the state of blood flow in the lower extremities in acute ischemia, both at the main and at the microcirculatory
Despite the fact that significant success has been achieved in the treatment of patients with infective endocarditis (IE), difficulties in clinical practice arise in the diagnosis of this disease. The article analyzes a clinical case of successful treatment of a patient with acute ischemia of the lower extremity due to thromboembolic syndrome in IE, the diagnosis of which was initially regarded as COVID-19. The clinical case occurred during the coronavirus infection (COVID-19) pandemic, and all patients who initially complained of fever were regarded as potentially infected, which, with insufficient examination, masked the clinical picture of infective endocarditis.
Выбор метода лечения острой ишемии верхней конечности (ОИВК) остается актуальной проблемой. При острых окклюзиях тромботического генеза, встречающихся в 5% наблюдений, успех хирургического лечения зависит от своевременной диагностики, а также от установления характера и локализации поражений артерий. В статье описано клиническое наблюдение успешного лечения ретромбоза артерий левой верхней конечности гибридным методом. Пациентка поступила с клинической картиной острой ишемии левой верхней конечности. Ранее пациентке выполнялась открытая тромбэктомия из левых подмышечной и плечевой артерий, артерий левого предплечья. При выполнении диагностической ангиографии выявлены гемодинамически значимый стеноз левой подключичной артерии до 80%, окклюзия на границе средней и дистальной третей плечевой артерии без восстановления кровотока в артериях предплечья. Экстренная операция проведена в 3 этапа в условиях гибридной операционной: выполнены стентирование левой подключичной артерии, открытая тромбэктомия из левой плечевой артерии и баллонная ангиопластика артерий предплечья. Кровоток был восстановлен на всех уровнях, что подтверждено данными компьютерной томографии. Пациентка выписана на 7-е сутки после операции с компенсированным кровообращением в верхней конечности. Таким образом, продемонстрирована возможность оказания экстренной хирургической помощи в условиях гибридной операционной при ОИВК, вызванной тромбозом вследствие атеросклероза.Финансирование. Исследование не имело спонсорской поддержки. Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.
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