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Results of treatment of 158 patients aged from 17 to 26 years with pyonecrotic complications of diabetic angiopathies are presented. Classification is proposed taking into account characteristics of purulent lesions (local, general, progressive), state of circulation in the damaged limb (major or collateral) and severity of ischemia for choice of treatment policy. Thanks to a sound policy based on these data recovery with limb safety was achieved in 130 (82.3%) patients, including 55 patients who had undergone reconstructive vascular operations or lumbar sympathectomy. High amputations were performed in 28 (17.6%) patients, in 12 of them--on the crus, and in 16--on the thigh. There were no lethal outcomes.

The work substantiates the indications for amputation of the lower limb in patients with obliterating diseases of the vessels. The main among them are progressive gangrene and decompensated ischemia of the limb in impossible performance of a restorative operation. It is pointed out that the level of the amputation should be chosen according to the condition of collateral circulation. Ultrasonic examination based on Doppler effect, allowing measurement of regional systolic pressure, is of principal significance in its evaluation. Analysis of the results of amputations in 111 patients with consideration for the value of regional systolic pressure showed that in 61 (51%) patients the amputation was performed through the leg or foot with immediate favorable results.

Reconstructive operations were carried out in the clinic on 437 patients with Leriche's syndrome in the recent 8 years. In 25 of them successive shunting of the vessels of the femoro-popliteal segment became necessary later because of inadequacy of the blood flow immediately after the first operation (15 patients) or consequent thrombosis of the femoral artery (10 patients). Trophic changes in the distal parts of the extremity, pain at rest or intermittent claudication occurring after 20-25 minutes of walking were the indications for resorting to successive shunting in the femoro-popliteal segment despite the maintained functioning of the shunt in the aortoiliac position. The deep femoral artery was used as the donor vessel in 12 operations among the 25 successive operations on patients with the Leriche's syndrome. It is noted that with the use of this vessel the successive operation becomes simpler technically and the length of the shunt can be reduced. Adequate restoration of blood flow in the extremity was attained in all patients after successive shunting of vessels in the femoral segment with the use of the deep femoral artery, and persisted for 6 to 12 months.

Experiments were conducted in 32 dogs to study the results of rheography, ultrasonic Dopplerometry, electric excitability of muscles, and tissue pH measurement in various periods of ischemia and after restoration of blood flow in the extremities. Clinical follow-up of 226 patients with injuries to the major arteries of an ischemic extremity confirmed the importance of the results of instrumental methods of examination for appraising the severity of ischemia and predicting its outcomes. The author distinguished four degrees of ischemia in injury to the vessels. Combination of clinical findings and the results of special methods of treatment makes it possible to choose the rational surgical tactics in traumas of the arteries of the extremities.