diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/2072-0351-3756diaendo-3756Research ArticleСтатьиArticlesДооперационная визуализация периферических артерий с применением ультразвукового дуплексного сканирования у пациентов с сахарным диабетоми критической ишемией нижних конечностейPreoperative visualization of peripheral arteries with duplex ultrasonography in patients with diabetes mellitus and critical limb ischemiaБондаренкоОльга НиколаевнаBondarenkoOlga Nikolaevna

к.м.н., в.н.с. отделения диабетической стопы

k.m.n., v.n.s. otdeleniya diabeticheskoy stopy

dia@endojournals.ruАюбоваНаталья ЛеонидовнаAyubovaN L

аспирант отделения диабетической стопы

aspirant otdeleniya diabeticheskoy stopy

dia@endojournals.ruГалстянГагик РадиковичGalstyanGagik Radikovich

д.м.н., проф., зав. отделением диабетической стопы

d.m.n., prof., zav. otdeleniem diabeticheskoy stopy

foot@endocrincentr.ruДедовИван ИвановичDedovIvan Ivanovich

академик РАН и РАМН, директор ФГБУ Эндокринологический научный центр

akademik RAN i RAMN, direktor FGBU Endokrinologicheskiy nauchnyy tsentr

dedov@endocrincentr.ruФГБУ Эндокринологический научный центр, МоскваEndocrinology Research Centre, Moscow201315062013162№2 (2013)5261Copyright © Бондаренко О.Н., Аюбова Н.Л., Галстян Г.Р., Дедов И.И., 20132013Бондаренко О.Н., Аюбова Н.Л., Галстян Г.Р., Дедов И.И.Bondarenko O.N., Ayubova N.L., Galstyan G.R., Dedov I.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/3756Цель

Цель. Оценить возможность проведения чрескожной транслюминальной баллонной ангиопластики (ЧТБА) артерий ниж- них конечностей у больных сахарным диабетом (СД) и критической ишемией нижних конечностей (КИНК) на основании данных ультразвукового дуплексного сканирования (УЗДС) без проведения диагностической рентгеноконтрастной ангиографии (РКАГ).

Материалы и методы

Материалы и методы. Обследовано 254 пациента (290 конечностей) с СД и КИНК. Все пациенты были разделены на 2 группы. В группе А в первой фазе исследования ЧТБА выполнена 132 пациентам с проведением дооперационной РКАГ. Во второй фазе исследования 122 пациентам ЧТБА баллонная ангиопластика артерий нижних конечностей была выполнена на основании данных УЗДС без дополнительного проведения РКАГ (группа Б). В исследовании оценивались согласованность результатов УЗДС и ангиографии (дооперационной/интраоперационной), диагностическая специфичность (ДС) и диагностическая чувствительность (ДЧ) дуплексного сканирования в определении уровня и локализации сосудистого поражения. Также были исследованы клинические факторы, влияющие на диагностическую точность УЗДС артерий нижних конечностей у больных СД.

Результаты

Результаты. В работе было показано оптимальное соответствие между УЗДС и РКАГ. Во второй фазе исследования согласованность, ДС и ДЧ УЗДС были достоверно выше для нижней трети поверхностной бедренной артерии и артерий голени, несмотря на наличие клинических факторов, затрудняющих визуализацию, таких как абдоминальное ожирение, выраженный кальциноз сосудистой стенки и периферические отеки.

Заключение

Заключение. Эффективная и точная ультразвуковая диагностика сосудистых поражений нижних конечностей позволяет определить выбор тактики эндоваскулярного вмешательства у пациентов с СД и КИНК без проведения дооперационной инвазивной визуализации сосудов в большинстве случаев.

AIM

AIM: To determine whether duplex ultrasonography (DU) without verification with diagnostic angiography (DA) is a sufficient visual- ization technique for pre-operative examination of patients with CLI (critical limb ischemia) indication for percutaneous transluminal balloon angioplasty (PTBA).

MATERIALS AND METHODS

MATERIALS AND METHODS: We examined 254 patients (290 limbs in total) with diabetes mellitus (DM) and CLI. All participants were subdivided into two groups: ?A? (PTBA with pre-operative DU+DA) and ?B? (PTBA with pre-operative DU). We evaluated data coherence between DU and DA (pre- or intraoperative) methods, as well as DU diagnostic specificity and sensitivity in determining degree and localization of vascular lesions. We also investigated specific clinical factors compromising DU diagnostic capabilities in patients with DM.

RESULTS

RESULTS: Our data suggests adequate coherence between DU and DA for pre-operative visualization. Group ?B? showed significantly higher diagnostic sensitivity and specificity for visualization of the lower third of superficial femoral artery and tibial arteries despite abdominal obesity, grossly evident calcification and peripheral edema.

CONCLUSION

CONCLUSION: Duplex ultrasound is efficient and precise enough to determine optimal management tactics in most patients with DMand CLI without resort to invasive methods.

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The authors declare that there are no conflicts of interest present.