We conducted an in-depth analysis of the results of clinical observations, laboratory and instrumental studies of 44 patients with stenotic-occlusive lesions of the great arteries of the lower extremities, who underwent open surgical interventions. In order to identify the significance of combined changes in indicators for predicting complications, information techniques were applied. Average values, сomparative analysis were first computed, and subsequently, correlation analysis was conducted. This research has proven the effective use of the above-mentioned techniques for identifying pairs of indicators, which suggests the possibility of using such changes as markers of the risk of complications. Thus, by knowing the indicators of complications, we can predict the occurrence of potential complications and, therefore, choose the safest and least invasive surgical technique.
The frequency of complications in the early and late postoperative period is closely related not
only to obliterating atherosclerosis as the main disease of the great arteries of the lower
extremities, but also to comorbid pathology, which can increase this frequency [
Given the systemic nature of peripheral artery disease (PAD), patients always have concomitant
chronic diseases. It has been proven that there is a 3-4 times higher risk of acute myocardial
infarction (MI) and sudden death compared to patients without PAD. Lesions of several vascular
segments are associated with worsening long-term treatment outcomes in patients with
stenoticocclusive lesions of the infrainguinal region [
Thus, it is important to determine the levels of risk and significance of a number of clinical and anamnestic indicators, both individually and in combination, to predict the risk of complications and select the optimal volume of surgical interventions.
Statistical analysis of clinical, instrumental, and laboratory data of 44 patients was conducted using
methods of variational and analytical statistics [
To assess the strength and direction of linear relationships between variables, the Pearson correlation coefficient (r) was calculated:
r = Σ [ ( Xᵢ - X ̄ )( Yᵢ - Ȳ ) ] / √ ([ Σ ( Xᵢ - X ̄ ) ^ 2 · Σ ( Yᵢ - Ȳ ) ^ 2 ] ) where:
Xi, Yi — individual data points XP,Ȳ — means of X and Y In case of nonparametric data, the Spearman rank correlation coefficient (ρ) was used: ρ = 1 - [ 6 · Σdᵢ ^ 2 ] / [ n ( n ^ 2 - 1 ) ] where: di — difference between the ranks of corresponding variables n — number of observations
An analysis was conducted on indicators from 44 patients to assess combined changes in the parameters of the studied groups, with the aim of improving the prediction of postoperative complication risks for open surgery. For this purpose, comparative and correlation analyzes were applied.
To determine the character and extent of atherosclerotic lesions in the arterial system of the lower extremities, all patients underwent determination of the clinical manifestations, examination using the SonoScape S8 Exp. ultrasound system (China) and contrast-enhanced computed tomography with the Siemens Brilliance CT64 scanner (Germany), focused on the vascular area.
The results of laboratory and instrumental studies, as well as clinical observations, were analyzed
using methods of variational and analytical statistic.
4.1. Evaluation of clinical symptoms and signs in patients
The following algorithm was used for the clinical examination of each patient. During medical
history taking, the first complaints of the patient were identified, namely, “intermittent
claudication”, which was noted by all patients (100%), the presence of pain at rest, which occurred
in 25 (57.12%) patients, changes in skin temperature and color in 44 (100%) patients, the presence of
hypotrichosis or hyperkeratosis in 44 (100%) patients, as well as trophic changes in the feet in 7
(16.6%) patients [
During the examination of each patient, pulsation was determined symmetrically (on both lower limbs) on the femoral, popliteal, tibial arteries, and arteries of the feet. 4.2. Anaysis of anamnestic and laboratory-instrumental indicators to determine criteria for predicting complications in open surgical interventions using information techniquesl Patients with stenotic-occlusive processes in the infrainguinal arterial segment, whose indicators were analyzed using information techniques, were divided as follows. The first group consisted of 44 patients who underwent open surgery: 1a – 34 patients without complications; 1b – 10 patients with complications. The results of clinical observations, laboratory and instrumental studies of 44 patients (group 1) were analyzed. Reconstructive surgeries included: In 14 cases ((31.82±7.02) %), allografting was performed, in 14 cases ((31.82±7.02) %) deep profundoplasty was performed, and in 16 cases ((36.36±7.25) %) autovenous bypass was used.
An analysis of anamnestic and laboratory indicators was performed in 34 patients (77.3%) without complications (group 1a) and 10 patients (22.7%) with complications (group 1b). The average age of patients in the first group was (66.45±1.32) years. The body mass index (BMI) in patients in this group was (14.84±0.68) kg/m². Harmful habits were found in (54.55±7.51) % of patients. The proportions of other anamnestic indicators were as follows: extracranial artery lesions 26% – (54.55±7.51) %, diabetes mellitus – (18.18±5.82) %, history of stroke – (4.55±3.14) %, history of myocardial infarction – (11.36±4.78) %, gastrointestinal tract pathology – (13.64±5.17) %, respiratory failure – (13.64±5.17) %, cardiovascular disease – (95.45±3.14) %, history of cancer – (2.27±2.25) %, types of anesthesia: regional anesthesia – (15.91±5.51) %, epidural anesthesia – (84.1±5.51) %, mechanical ventilation + intravenous – (2.27±2.25) %.
In patients of group 1a, the average age was (66.56±1.63) years, and the BMI was (15.37±0.84) kg/m², which did not significantly (p>0.05) differ from the similar indicators of patients in group 1 of the study. The proportion of harmful habits ((52.94±8.56) %) was at the same level (p>0.05) as in patients in group 1. The proportions of other anamnestic indicators also did not differ significantly (p>0.05) and amounted to: extracranial artery lesions 26% – (52.94±8.56) %, diabetes mellitus – (17.65±6.54) %, history of stroke – (5.88±4.04) %, history of myocardial infarction – (8.82±4.86) %, gastrointestinal tract pathology – (11.76±5.53) %, respiratory failure – (14.71±6.07) %, cardiovascular disease – (94.12±4.04) % (Figure 1), type of anesthesia: regional anesthesia – (20.59±6.93) %, epidural anesthesia – (79.41±6.93) %, mechanical ventilation + intravenous – (2.94±2.90) %. At the same time, patients in group 1-a had no history of oncological diseases.
Among the complications observed in patients in group 1b were: thrombosis of the reconstruction segment ((80.0±13.33) %), myocardial infarction ((10.0±10.0) %) and conduit infection ((10.0±10.0) %).
Respiratory failure 14,71% Gastrointestinal tract pathology
11,76%
Diabetes mellitus 17,65%
History of myocardial infarction 8,82%
History of stroke
5,88% Extracranial artery lesions 52,94%
Cardiovascular disease 95,45%
The average age of patients in group 1b was (66.1±1.91) years, and the BMI index was (13.05±0.81), which did not significantly (p>0.05) differ from the similar indicators of patients in groups 1 and 1a of the study. The proportion of harmful habits ((60.0±16.33) %) was at the same level (p>0.05) as in patients in the aforementioned study groups. The proportions of other anamnestic indicators also did not differ significantly (p>0.05) and amounted to: extracranial artery lesions – (60.0±16.33) %, diabetes mellitus – (20.0±13.33) %, history of myocardial infarction – (20. 0±13.33)%, gastrointestinal tract pathology – (20.0±13.33)%, respiratory failure – (10.0±10.0)%), history of cancer – (10.0±10.0)%) (Figure 2). At the same time, all patients in this group had cardiovascular diseases and predominantly used epidural anesthesia. None of the patients had a history of stroke, regional anesthesia, or mechanical ventilation.
Respiratory failure 10%
History of myocardial infarction 20% Gastrointestinal tract pathology
20% Diabetes mellitus 20%
Extracranial artery lesions 60%
History of cancer 10% Cardiovascular disease 95,45%
A comparative analysis of complete blood count, biochemical parameters, and coagulogram parameters of patients in all groups was also performed, the results of which are presented in (Table 2).
In group 1b, there was a tendency toward a decrease in the average color index (CI) (0.90±0.00) and leukocyte level (7.09±0.74) *109/L compared to similar indicators in group 1 (CI – (0.91±0.00), leukocytes – (8.07±0.53)*109/L) without a statistically significant difference (p>0.05).
When analyzing biochemical indicators in the group of patients with complications (group 1b), a significant (p<0.05) increase in LDL levels was found (3.72±0.29) mmol/L compared to similar indicators in the group of patients without complications ((2.95±0.09) mmol/L). There was also a tendency toward an increase in creatinine ((76.80±4.61) μmol/L), AST ((31.20±10.89) U/L), ALT ((28.18±6.28) U/L) and cholesterol ((4.98±0.24) mmol/L) in the specified group compared to the corresponding indicators in group 1a (creatinine – (68.48±3.15) μmol/L, AST – (16.11±3.09) U/L, ALT – (16.94±0.27) U/L, cholesterol – (4.50±0.30) mmol/L), but no significant difference (p>0.05) was found. There was also a tendency toward increased levels of creatinine, AST, ALT, cholesterol, LDL, as well as K ((5.22±0.38) mmol/L) in group 1b compared to the corresponding indicators of the general (1st) group (creatinine – (70.37±2.64) μmol/L, AST – (19.54±2.65) U/L, ALT – (19.49±1.90) U/L, LDL cholesterol (3.12±0.24) mmol/L, K – (4.80±0.11) mmol/L, cholesterol – (4.61±0.20) mmol/L) without statistically significant differences (p>0.05).
1 group (n – 44) 4,29±0,12 124,89±3,03 0,907±0,004 8,07±0,53 2,50±0,38 6,70±0,73 65,45±1,38 18,45±1,56 3,52±0,47 15,80±2,66 5,78 ± 0,21 70,37±2,64 5,60±0,29 19,54±2,65 19,49±1,90 8,80±0,62 4,80±0,11 138,32±0,79 3,12±0,24 1,20±0,06 4,61±0,20 4,17±0,27 11,51±0,22 93,49±2,73 0,99±0,03
According to the results of coagulogram analysis, patients without complications (group 1-a) tended to have lower INR values (0.95±0.04) compared to group 1 (0.99±0.03), but this difference was not statistically significant (p>0.05).
An analysis of the correlation [
A study of the correlation between similar indicators of general blood analysis in patients in groups 1-a and 1-b (Figure 3) revealed a positive moderate correlation between the values of erythrocyte levels (+0.41), hemoglobin (+0.46), ESR (+0.43), and segmented neutrophils (+0.37). The correlation between other indicators was weak to very weak.
neutrophils
neutrophils
Erythrocytes – +0,47 -0,33 -0,02 -0,21 +0,18 +0,11 -0,04 -0,40 Hemo globi n +0,47 – +0,04 +0,27 +0,24 -0,22 +0,22 -0,25 -0,19 Leuk ocytes -0,33 +0,04 – -0,22 +0,30 +0,22 +0,22 +0,06 +0,05 Eosin ophils -0,02 +0,27 -0,22 – +0,28 -0,73 -0,73 -0,17 +0,29 Rodshape d neutr ophils -0,21 +0,24 +0,30 +0,28 – -0,16 -0,16 -0,73 -0,56 Segmented neutr ophils +0,18 -0,22 -0,09 +0,13 -0,22 – -0,51 -0,25 +0,17 Lymphocytes +0,11 +0,22 +0,22 -0,73 -0,16 -0,51 – +0,32 -0,20
-0,04 -0,25 +0,06 -0,17 -0,73 -0,25 +0,32 – +0,57 -0,40 -0,19 +0,05 +0,29 -0,56 +0,17 -0,20 +0,57 –
The analysis of the correlation between the biochemical blood parameters of patients in group 1-b of the study (Table 4) established a strong positive correlation between AST and ALT values (+0.86), a moderate positive correlation between LDL and cholesterol values (+0.69), creatinine and urea (+0.58), creatinine and cholesterol (+0.58), total bilirubin and cholesterol (+0.51), AST and Na (+0.58), ALT and Na (+0.61), K and HDL (+0.53), as well as a positive moderate correlation between urea and K (+0.35), bilirubin and LDL (+0.44), K and HDL (+0.35). There was a negative strong correlation between creatinine and AST (-0.72), a negative moderate correlation between urea and AST (-0.53), as well as a negative moderate correlation between ALT and total bilirubin (-0.48), ALT and creatinine (-0.47), urea and Na (-0.47), ALT and cholesterol (-0.34), AST and total bilirubin (-0.30), and AST and cholesterol (-0.31). The correlation between other indicators was weak and very weak.
A study of the correlation between similar indicators of general biochemical blood analysis in patients in groups 1-a and 1-b (Figure 4) established a positive average correlation between glucose levels (+0.53) and a positive moderate correlation between urea levels (+0.53). There was a negative average correlation between cholesterol (-0.67) and AST (-0.50) levels, as well as a negative moderate correlation between LDL (-0.36) and ALT (-0.45) levels. The correlation between other indicators was weak and very weak.
The analysis of the correlation between the coagulogram parameters of patients in group 1b of the study (Table 5) revealed a positive moderate correlation between INR values and fibrinogen levels (+0.30). There was a negative average correlation between the Protrombin time (PT) values and INR (-0.66). The correlation between other parameters was weak and very weak. -0,02 -0,03
Cholesterol -0,1
LDL
К ALT
Urea
Glucose -0,8 -0,6 -0,4 -0,2 0 0,2 parameters of the group of patients with
A study of the correlation between similar coagulogram indicators in patients in groups 1-a and 1-b revealed only a weak correlation between prothrombin levels according to Quick (-0.24) (Figure 4). The correlation between other indicators was weak to very weak.
An analysis of the anamnestic and clinical-laboratory indicators of patients with obliterating atherosclerosis of the great arteries of the lower extremities who underwent open surgical interventions revealed that among the complications in 8 patients of the first group, thrombosis of the reconstruction segment was observed (18.2%), one patient had myocardial infarction (2.3%), and one had conduit infection (2.3%).
In patients with complications, the average age was (66.1±1.91) years, and the BMI was (13.05±0.81) kg/m², which did not significantly (p>0.05) differ from the similar indicators of patients in groups 1 and 1a of the study. The proportion of harmful habits ((60.0±16.33) %) was at the same level (p>0.05) as in patients in the aforementioned study groups. The proportions of other anamnestic indicators also did not differ significantly (p>0.05).
During the analysis of biochemical parameters in the patient group with complications (group 1b), a significant (p<0.05) increase in LDL levels was found (3.72±0.29) mmol/L compared to the same indicator in the group of patients without complications ((2.95±0.09) mmol/L). According to the results of the coagulogram analysis of patients in group 1-a, there was a tendency toward a lower INR index (0.95±0.04) compared to the corresponding indicator in group 1 (0.99±0.03), but this difference was not statistically significant (p>0.05).
A study of the correlation between the indicators of the general blood test of patients with complications established a positive average correlation between the values of monocyte fractions and ESR levels (+0.57) mm/h, a positive moderate correlation between the values of erythrocyte and hemoglobin levels (+0.47), leukocyte levels and the percentage of rod-shaped neutrophils (+0.30) and the percentage of lymphocytes and monocytes (+0.32), which indicates the significance of the combined changes of the indicated pairs of indicators for predicting the development of complications.
The analysis of the correlation between the biochemical blood parameters of patients in the study group with complications revealed a strong positive correlation between AST and ALT values (+0.86), a moderate positive correlation between LDL and cholesterol values (+0.69), creatinine and urea (+0.58) , creatinine and cholesterol (+0.58), total bilirubin and cholesterol (+0.51) AST and Na (+0.58), ALT and Na (+0.61), K and HDL (+0.53), AST and ALT (+0.86), a positive moderate correlation between creatinine and urea (+0.58), AST and Na (+0.58), ALT and Na (+0.61), K and HDL (+0.53), a positive moderate correlation between urea and K (+0.35), bilirubin and LDL (+0.44), K and LDL (+0.35), as well as a positive moderate correlation between INR values and fibrinogen levels (+0.30), indicating the significance of combined changes in these pairs of biochemical indicators for predicting the development of complications.
Correlation assessment of similar variables of general, biochemical blood analysis in patients
with and without complications in the study groups established a negative average correlation
between cholesterol levels (-0.67), AST (-0.50), indicating the possibility of using such changes as
markers of the risk of complications [
There were no external sources of funding and support. No fees or other compensation were paid. The authors who participated in this study declared that they have no conflict of interest regarding this manuscript.
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