• V. I. Rusin
  • P. A. Boldizhar
  • V. V. Rusin
  • F. V. Gorlenko
  • M. M. Lopit
Keywords: critical ischemia, transcutaneous tension, angiosomes, revascularization, regional perfusion index.


Summary. The aim of the study. To study the effectiveness of the proposed surgical methods in the treatment of critical ischemia of the lower extremities.

Materials and methods. In our work the analysis of results of treatment of 36 patients with chronic critical ischemia of the lower extremities who were on treatment in ZOKL of them is presented. Andriy Novak. Grade III A ischemia was diagnosed in 11 patients, grade III B — in 15, grade IV — in 10 patients and studied the microcirculation of the lower extremities in 31 people without pathology of the cardiovascular system, taking into account the angiosomal approach.

We found that the highest rates of perfusion units on the thigh were found in the basin of the sciatic and posterior arteries, the lowest — in the basin of the deep femoral artery and popliteal artery.

On the shin, the highest rates of microcirculation were found in the basin of the posterior tibial artery, the lowest - on the foot.

Results and discussion. The level of regional perfusion of the corresponding angiosomes of the skin of the lower extremities after anastomosis between the anterior tibial artery and anterior tibial vein showed that the improvement of microcirculation is observed in those angiosomes whose blood supply is provided by the anterior tibial artery and its artery and artery.

When creating anastomoses between the posterior tibial artery and the posterior tibial vein, the microcirculation in the skin increased 3-5 times compared to baseline and its level was 70 % of normal in those angiosomes, which supply blood to the posterior tibial artery and its continuation on the foot. At the same time, there is an increase in skin microcirculation in the angiosome of the tibial artery, which is apparently due to the presence of a relatively large number of first-type anastomoses in the triceps.

In our opinion, any of the proposed treatments should begin before the development of critical ischemia.

Conclusions. The dependence of skin perfusion on the main arterial blood flow is proved taking into account the angiosomal theory, which allows to use this method in the diagnosis and evaluation of the results of treatment of chronic critical ischemia of the lower extremities.

Microcirculation of the skin of the lower leg and foot improves 3.5–5 times 30 days after the creation of arteriovenous fistula below the occlusion of the anterior tibial artery and posterior tibial artery in chronic critical ischemia of the lower extremities.


1. Rusin VI, BoldIzhar PO, Gorlenko FV, LopIt MM. Kil-kisni pokazniki mikrotsirkulyatsiyi shkiri nizhnih kintsivok. Suchasni medichni tehnologiyi. 2020; 4(47): 31-35. [In Ukr.].
2. Novikov YuV, Fomin AA, Pershakov DR. Effektyivnost sosudistyih anastomozov v stimulirovanii kollateralnogo krovotoka. Vrach-aspirant 2019; 92(1): 43-50. [In Rus.].
3. Rusin VI, Korsak VV, Boldizhar PA, Rusin VV, Pekar MI, Gorlenko FV, Langazo OV. Otdalennyie rezultatyi hirurgicheskogo lecheniya kriticheskoy ishemii nizhnih konechnostey posle odnomomentnoy pryamoy i nepryamoy revaskulyarizatsii. Novosti hirurgii. 2017; 25(2):131-139. [In Rus.].
4. Gray, Bruce H. Peripheral vascular intervention is better than tibial bypass for critical limb ischemia. (2017); 35-36.
5. Leenstra B, Wijnand J, Verhoeven B, Koning O, Teraa M, Verhaar MC, Borst GJ. Applicability of transcutaneous oxygen tension measurement in the assessment of chronic limb-threatening ischemia. Angiology. 2020;71(3):208-16.
6. Novikov YuV, Fomyin AA, Pershakov DR. Novyiy vzglyad na angiosomnuyu teoriyu s tochki zreniya mikrotsirkulyatsii. Sovremennyie problemyi nauki i obrazovaniya. 2015; 1(1):1362-1362. [In Rus.].
7. Gavrilenko AV, Kotov AE, Lepshokov MK. Profundoplastika v hirurgicheskom lechenii bolnyih s hronicheskoy kriticheskoy ishemiey nizhney konechnosti. Annalyi hirurgii. 2018;23(1):42–6. [In Rus.].
8. Gorlenko FV. Rezultati pryamoyi revaskulyarizatsiyi distalnih form urazhennya arteriy nizhnih kintsI\ivok. Problemi klinichnoyi pediatriyi 2017; 3(4): 119-123. [In Ukr.].
How to Cite
Rusin, V. I., Boldizhar, P. A., Rusin, V. V., Gorlenko, F. V., & Lopit, M. M. (2021). DISTAL ARTERIOVENOUS FISTULAS IN THE TREATMENT OF CHRONIC CRITICAL LOWER LIMB ISCHEMIA. Kharkiv Surgical School, (1), 106-111. https://doi.org/10.37699/2308-7005.1.2021.20