Diagnostic and treatment approach in non-traumatic acute limb ischemia: Summary of PhD thesis in medical sciences: 321.13 – Surgery

Abstract

Structure of the thesis. The thesis includes 167 pages of the main text: introduction, five chapters, general conclusions and practical recommendations, 25 figures and 21 tables. The bibliography includes 218 references. The principal results of the study were published in 22 scientific papers. Key words: acute limb ischemia, clinical diagnosis, imaging, surgical treatment. The aim of study. Determination of the possibilities for improving the diagnosis and treatment of patients with acute limb ischemia, based on the identification of perioperative factors that have a negative impact on the results of urgent revascularization interventions. Objectives of the study. Study of the demographic, clinical and paraclinical characteristics of the contemporary cohort of patients with acute limb ischemia undergoing revascularization interventions. Evaluation of preoperative management and assessment of the value of different diagnostic methods of acute limb ischemia. Development of the method for predicting the early outcome of revascularization interventions, based on available criteria for analysis at the preoperative stage. Analysis of early and long-term results after urgent revascularization interventions and identification of factors associated with amputation risk and/or patient death. Determining the particularities of clinical evolution and surgical treatment results in acute upper limb ischemia and in cases associated with SARS-CoV-2 infection. Scientific originality and novelty. For the first time in the Republic of Moldova, a prospective scientific cohort study was carried out in patients with acute limb ischemia and allowed the complex evaluation of the clinical and demographic characteristics, the peculiarities of the diagnostic-curative approach and the results of the treatment. For the first time, the use of non-contact infrared thermometry was proposed for the pre- and postoperative examination of patients with acute limb ischemia. It has been shown that the degree of patient frailty and the severity of ischemia, evaluated with the help of the "MoST-Do" score developed in the study, represent the true risk factors associated with the unfavorable outcome of revascularization interventions. Prospective external validation of the value of the Baligh ultrasound sign was performed and demonstrated its acceptable diagnostic performance in determining the cause of arterial occlusion. Theoretical significance and applicative value. The identification of preoperative risk factors, associated with the failure of the revascularization intervention in patients with acute limb ischemia, allowed the prediction of the outcome of the operation and the scientifically reasoned selection of the curative tactics. Based on the research results, was demonstrated the necessity and usefulness of including non-contact infrared thermometry examination in the diagnostic procedure, applied to patients with acute limb ischemia. The study data identified a number of possibilities for improving the outcomes of treatment of acute limb ischemia: education of patients in risk group; rational use and monitoring the effectiveness of antithrombotic treatment; prognosis, early diagnosis and appropriate treatment of compartment syndrome and ischemia-reperfusion syndrome. Implementation of scientific results. The results of study were implemented in the clinical activity of the departments of surgery at Institute of Emergency Medicine from Republic of Moldova. Seven acts of implementation of the results were registered.