Bagrat gegamovich, only recently has the centre got back to routine work after two months of service covide. And immediately found out most comes of patients who require surgery on the blood vessels of the legs. Why? Affected nearly three-month conversion under kovid?
Bagrat Alekyan: Only to some extent. No more. The problem of vascular disease of the legs appeared not yesterday and not suddenly. She’s an old and very heavy. But the system of modern to help such sufferers to this day in the country. Don’t want to scare, but nothing in our conversation cannot do without statistics. Every year in our country is performed more than thirty thousand amputations of the feet about gangrene. What this leads to? Two culprits: diabetes and atherosclerosis. These diseases are terrible in and of themselves, and because they are for all ages.
And the only salvation the amputation? In our century, the century of modern methods of technologies of treatment of the same atherosclerosis and diabetes? Yes, and you have other statistics – statistics saved feet. How to get into these statistics?
Bagrat Alekyan: don’t be surprised, first of all, requires the attentive relation of man to himself, to his health. Believe me, often is to blame the patients themselves. That’s sick leg. The man stopped, waited until the pain will pass, and went on. This situation repeated itself? The same steps. Although the distance of the passage without the pain becoming less, they leave, like shagreen leather. And operates the popular Russian random. There is no need to rely on him! It often leads to the formation of open wounds on the leg (legs). Occurs gangrene, which can cope only by means of amputation.
during the first years die 25 percent of patients suffering from critical ischaemia of the legs. And only 45 percent is the safety of the feet. After five years away from the life of 60% of such patients. And most importantly: these patients often suffer and die from myocardial infarction and stroke. Sore feet – a victim of the atherosclerosis that affects the blood vessels of the heart and brain.
let’s sanprosvet. What you need to know about the condition of their feet the patient? What should pay attention to? And finally, where to go with the trouble?
Bagrat Alekyan: the First symptom is the occurrence of pain in the legs. His legs tire quickly, as the heroine of the great Ostrovsky, “feet Godot”. Do not expect miracles – urgently to the doctor! What? Ask your GP referral to the surgeon.
You are a dreamer! Surgeons not in all clinics. And the farther away from Moscow, those more difficult to find the right specialist.
Bagrat Alekyan: Today, the main method of diagnosis is ultrasonography. And now it is pPoliclinico of the country.
You are the eternal optimist. Many examples when in the field, especially in the provinces, no ultrasound no. We haven’t got rid of the effects of the optimization of health service, especially primary care. But let’s hope for the best. So… the Diagnosis is made on time. Next?
Bagrat Alekyan: Then the conservative treatment. It takes place in an outpatient setting. Assigned appropriate medications. Is observation. It would seem that everything is simple. But… Again: we do not always love ourselves. That was slightly better and my treatment. And meanwhile the process goes on. And formed irreversible changes in the toes. An amputation is needed. Until recently, she performed vascular surgeons and experts on wounds and wound infections. The patient was rid of the pain of the wound. But all my life she became disabled. Among such disabled a lot of very young people.
Over time, it became clear that vascular surgery on the arteries of the lower leg are not effective. In the last 15-20 years worldwide used in clinical practice in endovascular surgery. They allow you to operate vessels with a diameter of one to three millimeters. Practically, this piece of work In our country in 2019, unfortunately, made only 10 thousand of these endovascular operations.
are Made where? Ozvuchte geography.
Bagrat Alekyan: , Such operations are performed in almost 200 centres in the country.
nowadays it is possible to do without amputation?
Bagrat Alekyan: Your question is incorrect. There is no straight answer. There are situations that are typically associated with delays in seeking patients. When there is no alternative. But if all the time, the legs can and should be saved. So, to save a normal person’s life. The one indispensable condition: your heart and blood vessels of the patient must be under constant supervision of a cardiologist. Once again: 80 percent of patients with foot problems, suffer the most severe diseases of the heart and blood vessels of the brain. Which means that they primarily threaten the heart attack and stroke.
Show erudition. Endovascular surgery to save the leg using a special stent and balloon under local anesthesia are injected into the damaged vessel and allow you to restore the blood flow in the leg. To save the leg. That is so simple to the untrained eye. Just. But it is very expensive. Expensive and stents, and cylinders, and other support intervention. Now: price of salvation?
Bagrat Alekyan: under the MLA is released 70 thousand rubles. And the approximate cost of instrumentation for this operation is 120 thousand rubles. The only region of the Russian Federation, which assumed the full payment of the treatment of this category of patients, to Moscow. She has allocated for the treatment of a VI�� such a patient 370 thousand rubles.
And in other regions?
Bagrat Alekyan: This problem is not resolved. What to do? A radical solution to the question of medical care of this category of patients. This including and struggle with disabilities. And so goes beyond the purely medical framework. This socio-economic problem. The national project for the establishment of vascular centres to assist patients with heart attack and stroke in the country created more than 200 vascular centers.
Now you need to use the potential existing in the country more than 360 centers in endovascular surgery, to take the next step: to help patients with critical ischemia of the legs. And following the example of Moscow, to seek funds on a Federal level. After all, if all the calculate, the modern survival of patients would be cheaper than the cost of their treatment, disability.
