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Experience of surgical treatment of 166 patients with severe lower limbs ischemia is summarized. The parameters of regional hemodynamics got with the help of ultrasound dopplerography, electro-magnetic flowmetry, percutaneous pO2 monitoring in the foot skin and registration of peripheral resistance of artery in distal anastomosis zone were used for prognostication of the vascular transplant function while aorto-femoral and femoro-popliteal segments reconstruction. The choice of surgical procedure tactics in accordance with prognosticated outcome permitted to lower the prevalence of an early postoperative complications from 17 to 8.4%.

Possibilities to prognose the effect of reconstructive operation on the lower extremity vessels are shown on the basis of transcutaneous of oxygen on the dorsal surface of the foot in complex with ultrasonic Dopplerometry in patients with severe ischemia of lower extremities. Effectiveness of the test with the orthostatic growth of Po is proved. An examination of 60 patients with severe ischemia of lower extremities and 10 patients without pathology of main vessels (control group) was performed. Operations were performed on 48 patients, in 35 of them reconstructive operations were made. No correlation was found between preoperative value of Po and a result of the reconstruction. A correlation was found between the value of the orthostatic growth of Po and outcome of the reconstructive operation. The average growth of Po in the group of patients with a negative outcome of the reconstruction made up 9.93 + 2.78 mm Hg, with a positive outcome it was 14.137 + 2.30 mm Hg (p < 0.05). In patients with malleolus index of the regional systolic pressure > 0.3 with the orthostatic growth of Po > 20 mm Hg the probability of positive prognosis of the reconstruction made up 88.8%.

The paper discusses whether the outcome of reconstructive surgery can be predicted by using the orthostatic test in Doppler sonography and transcutaneous polarography. A total of 97 patients with severe lower extremity ischemia were studied, of them 87 were operated on. Reconstructive operations on the vessels were performed in 72 patients. There was no relationship between the value of the humero-mallear index of regional systolic pressure as well as TcpO2 and the outcome of an operation. At the same time there was a correlation between the orthostatic rise in regional systolic pressure on the tibial arteries at the ankle-bone and the orthostatic increase in pO2 in the feet and the outcome of a reconstructive operation. The orthostatic rise in pO2 and regional systolic pressure was 8.06 +/- 4.0 and 58.2 +/- 5.43 mm Hg in patients with poor outcomes and inoperable patients, respectively. In good outcomes, these figures were 17.8 +/- 2.14 and 91.3 +/- 3.64 mm Hg (p < 0.05), respectively. The positive outcome of a reconstructive operations was observed in 88.8 = 92.0% patients with an orthostatic rise of pO2 in the feet by more than 20 mm Hg and that at the ankle-bone by more than 90 mm Hg.

The experience with surgical treatment of 107 patients with severe ischemia of the lower extremities, including 52 with associated lesion of the vessels of the aorto-femoral and femoro-popliteal segments, is summarized. A complex of preoperative and intraoperative assessment of regional hemodynamics was used. This permitted to avoid the amputation of an extremity in 86.6% of the patients.

According to the results of examination of 170 patients with atherosclerotic lesions of the vessels of the aortofemoral segment and 170 virtually healthy subjects by means of the tetrapolar rheography, the prognostic value of the hypokinetic type of circulation in the development of cardiologic complications after reconstructive operations on the vessels mentioned was established. It is admitted that the value of cardiac index equal to 1.4 l/(min.m2) is a contraindication for the performance of reconstructive-restorative operations on the vessels of the aortofemoral segment.

Results of the surgical treatment of 19 patients are discussed. Extrathoracal methods of correction of occlusive injuries of proximal portions of the brachiocephalie arteries are shown to be expedient. The intraoperative flowmetry has shown the safety of using the common carotid artery as the donor for revascularization of brachiobasilar reservoir of blood circulation.

By the method of transesophageal electrostimulation of the left auricle, 98 patients with Leriche's syndrome were examined. Of them in 51, the coronary disease was revealed. The degree of ischemic changes in the terminal part of the ventricular complex were defined by the rate of stimulation, depth of the ST segment shift, and duration of ischemic depression. The nitroglycerin test permitted to evaluate the anti-ischemic effect of the drug, quality and effectiveness of the preoperative preparation. In patients with negative or doubtful anti-ischemic effect, the risk of the development of cardiac complications increases.