Fig 3 - uploaded by Roman Goloshchapov-Aksenov
Content may be subject to copyright.
Computer angiogram of the arteries of the lower extremities of a patient with chronic cri tical ischemia of the left lower limb. Stenosis of the left common iliac artery 80% (1), left external iliac artery 95% (2), left superficial femoral artery 95% (3) and proximal occlusion of the tibial and fibular arteries(4), stenosis of the proximal right common iliac artery 70% (5)
Source publication
Aim. To study technical problems in the provision of endovascular care and to develop technological solutions for its improvement based on endovascular biometry. Methods. For the period 20152019 an expert analysis of the results of endovascular treatment of 1546 patients with chronic lower limb ischemia was performed, in which it was not possible t...
Context in source publication
Context 1
... makes it difficult to advance catheters and guidewires along vessels during the endovascular care and require the use of assistive devices or engineering solutions to effectively complete and complete operations. Figure 3 shows a computer angiogram of the lower extremities arteries from patients with chronic critical ischemia of the left lower extremities, caused by atherosclerotic stenosis of the left common iliac artery 80% (1), left external iliac artery 95% (2), left superficial femoral artery 95% (3) and proximal occlusion of the tibial and fibular arte ries (4). The patient also revealed a narrowing of the proximal right common iliac artery 70% (5). ...
Similar publications
Citations
Highlights . The basis for improving the quality of medical care is the arrangement of algorithms for clinical processes. The choice of a clinical and organizational solution for cardiovascular diseases in groups of older age patients at the stage of primary healthcare is a complex medical and economic task that requires maintaining the balance of efficiency, safety and quality of life in the "patient – risks – survival – economic efficiency" system. The development of an algorithm for making clinical and organizational decisions concerning cardiovascular diseases in elderly patients to improve the effectiveness of primary healthcare is an urgent health issue.
Aim. To develop and evaluate the effectiveness of the algorithm for making clinical and organizational decisions at the primary healthcare stage for elder patients with cardiovascular diseases.
Methods. The bases for the study were conducted in 2016–2020 at the Vascular Surgery Department of Peoples Friendship University of Russia and the Central Clinical Hospital “RZD-Medicine”. The object of the study was the patients with cardiovascular diseases (n = 422), mean age 76.11±7.2 years old. The subject of the study was cardiovascular surgeons (n = 4) experienced in surgical and endovascular technology. The algorithm was based on the content analysis of scientific publications (n = 27), clinical practice, the organizational and technological algorithm of PHC (primary healthcare) developed by Abramov A.Yu. and the colleagues in 2020 and the recommendations for the care of the elderly people with polymorbidity developed by the American Geriatric Society (2012). The medical, social and clinical effectiveness as well as the economic results of inpatient treatment were evaluated. The periods before and after the implementation of the algorithm in 2016–2017 and 2018–2020 were compared. Content analysis, analytical, statistical, mathematical, comparative, and expert research methods were applied.
Results . The developed PHC (primary healthcare) algorithm contributed to the high level of accessibility of endovascular care (100%). Cardiovascular surgeons positively assessed the possibility of providing surgical care in 100% of cases and patient adherence to surgical treatment (99.5%). In 2016–2017 and 2018–2020 the surgical activity of the vascular surgery department significantly increased from 7 to 98.9%, the average bed-day decreased from 9.5 to 6.8 days and the postoperative bed-day from 7.2 to 4.12 days, the frequency of repeated hospitalizations in the hospital decreased during the year from 3.1±0.2 to 1.6±0.4 times, the incidence of primary acute myocardial infarction from 12 to 0% and relapses of critical ischemia of the lower extremities from 36 to 2%. The average cost of direct medical costs for the treatment of one patient during the year in the main and control groups did not differ significantly, 4 086$ (USA) и 3 887$ (USA), respectively.
Conclusion. The PHC development and experience algorithm indicates the increase in the medical, social and clinical effectiveness of medical care for cardiovascular diseases in patients of older age groups and helps to reduce the direct costs of inpatient care.
