Prevention of gastrointestinal bleeding in patients after endovascular surgery on the arteries of the lower extremities for critical ischemia in diabetes mellitus

Abstract

Relevance: Patients with critical lower limb ischemia and diabetes mellitus are the most difficult group of patients in terms of a favorable outcome of the disease. The number of such patients increases annually. When treating these patients, it is necessary to take into account many different pathological conditions that can lead to fatal complications in the perioperative period. The purpose of the work: The aim of the work was to study methods of prevention of gastrointestinal bleeding in patients after endovascular surgery on the arteries of the lower extremities for critical ischemia in diabetes mellitus. Material and methods: The prospective study included 220 patients who were treated in the vascular surgery department of the A. A. Polyantsev General Surgery Clinic of the Volgograd State Medical University for obliterating atherosclerosis of the arteries of the lower extremities and diabetes mellitus in the period from 2017 to 2021 inclusive. All patients were diagnosed with critical ischemia of the lower extremities stage IIIIV ischemia according to the Fontaine-Pokrovsky classification. Results and discussion. The relationship between the number of painkillers taken per day to reduce pain syndrome and erosive and ulcerative lesions of the gastric mucosa and duodenum in both groups was noted. Conclusion: All patients with peripheral artery diseases accompanied by critical ischemia had endoscopic changes from gastritis to ulcerative lesions, including those complicated by bleeding, by the time they sought specialized medical care. The group at increased risk of gastrointestinal bleeding is patients with repeated reconstructions, surgical corrections of complications or amputations at various levels (from finger to hip), as well as taking anticoagulants in therapeutic dosage. Routine prevention of gastrointestinal bleeding with proton pump inhibitors is not acceptable for this group of patients.