Главный военный клинический госпиталь им. Н.Н. Бурденко
Центр сердечно-сосудистой хирургии
Отделение рентгенохирургических методов диагностики и лечения
Москва,
Госпитальная площадь, 3.
Проезд от станций метро:
м. Семеновская,
м. Авиамоторная.
В стоимость операций включен полный набор необходимых стационарных услуг и все медицинские материалы:
- Пребывание в стационаре с питанием;
- Необходимые лабораторные и диагностические исследования;
- Проведение операции, включая весь необходимый медицинский инструментарий;
- Медицинский инструментарий последних поколений ведущих мировых производителей.
| Наименование операции | Цена, Р |
|---|---|
Ангиопластика артерий нижних конечностей
(при необходимости стентирования, дополнительно оплачивается стоимость имплантации каждого стента 70.000)
Ангиопластика и стентирование коронарных артерий с имплантацией 1 стента
консультация
88002221170
из россии звонок бесплатный
Новости
Всероссийская конференция сосудистых хирургов в Ярославле
13-15 сентября 2018 года в Ярославле состоялась конференция Российского общества ангиологов и сосудистых хирургов. Врачи нашего центра приняли в ней активное участие. Выступали с докладами и клиническими случаями. Модерировали секцию по критической ишемии. В целом, конференция прошла на качественно новом уровне, с использованием современных интерактивных технологий. Она вызвала значительный интерес в профессиональной среде. 16 сентября 2018 года
Дополнительная информация
Из чего складывается стоимость лечения
1. Стоимость хирургического вмешательства — самый дорогой этап лечения, связанный с использованием высокотехнологичного одноразового материала и обурудования.
2. Стоимость анестезиологического пособия — на каждой операции работает анестезиологическая бригада, контролирующая безболезненное проведение вмешательства и контроль жизненных параметров.
3. Стоимость лечения в клинике, включающая расходы на лекарственные препараты, перевязочные материалы, анализы и дополнительные обследования, работу персонала клиники по уходу из расчета на один койко-день.
Полезная информация
Как определяется стоимость операции
1. Стоимость одноразового расходного материала на операцию (стенты, проводники, ангиографические зонды и катетеры)- это наиболее затратная статья расходов.
2. Стоимость амортизации хирургического инструмента, ангиографической установки, следящей и хирургической аппаратуры, расходов на электрообеспечение операционной — 10% стоимости операции.
3. Стоимость текущих и регулярных работ по поддержанию стерильности помещения и асептической вентиляции операционной — 5%.
4. Заработная плата персонала (хирургов, анестезиологов, операционных сестер, анестезисток и санитарок) — 20%.
Рентабельность открытых операций составляет 10%, эндоваскулярных — 5%.
Мы сохраняем ногу при гангрене! Звоните 8 (800) 222 11 70 (по России бесплатно)
| Наименование стандарта лечения | Стоимость стандарта лечения |
| Диагностика в амбулатории | |
|---|---|
| Консультация документов пациента в амбулатории (просмотр выписок, фотографий, ангиограмм, дисков КТ) | 1000 рублей |
| Консультация сосудистого хирурга | 2000 рублей |
| Консультация ведущего сосудистого хирурга клиники Калитко И.М. | 3000 рублей |
| Ультразвуковое ангиосканирование артерий нижних конечностей | 2000 рублей |
| Ультразвуковое сканирование вен нижних конечностей | 1500 рублей |
| Ультразвуковое ангиосканирование магистральных артерий головы | 2000 рублей |
| Транскраниальное УЗИ исследование | 1500 рублей |
| Эхокардиография | 2000 рублей |
| Контрастная ангиография нижних конечностей | 20 000 рублей |
| Селективная ангиография периферических сосудов | 20 000 рублей |
| Коронарография | 20 000 рублей |
| Мультиспиральная КТ ангиография одного бассейна | 20 000 рублей. |
| Ориентировочная стоимость лечения в стационаре | |
| (не является публичной офертой) | |
| Лечение критической ишемии нижних конечностей без гангрены | 220 000 рублей |
| Лечение гангрены нижней конечности | 250 000 рублей |
| Лечение острой ишемии нижних конечностей с диализом | 250 000 рублей |
| Лечение патологии сонных или позвоночных артерий | 220 000 рублей |
| Лечение аневризмы аорты (открытая операция) | 300 000 рублей |
| Лечение аневризмы эндоваскулярно EVAR | 1 000 000 рублей |
| Экстренная операция при инфаркте | Бесплатно по полису ОМС |
| Плановое лечение ИБС (ангиопластика и стентирование) | 230 000 рублей |
Стоимость коронарографии и вмешательств на сосудах сердца
Название услуги
Стоимость в рублях
Диагностика и операции
Имплантация стентов без лекарственного покрытия
Имплантация биодеградируемых стентов и стентов с лекарственным покрытием
Установка электрокардиостимулятора
Стоимость открытых операций
| Наименование операции | Стоимость (руб) | Обезболивание 20% от стоимости операции |
| Операции на аорте | ||
| Хирургический доступ к торако-абдоминальному отделу аорты | 110 000 | Наркоз |
| Аорто-бедренное шунтирование | 132 000 | Эпидуральная анестезия |
| Аорто-бифеморальное шунтирование | 176 000 | Эпидуральная анестезия |
| Аорто-бифеморальное протезирование с реплантацией висцеральных ветвей | 198 000 | Наркоз |
| Резекция аневризмы брюшной аорты | 220 000 | Наркоз |
| Удаление нагноившегося сосудистого протеза аорты | 165 000 | |
| Операции на бедренном уровне | ||
| Подмышечно-бедренное шунтирование | 121 000 | Эпидуральная анестезия |
| Бедренно-бедренное перекрестное шунтирование | 110 000 | Эпидуральная анестезия |
| Расширенная профундопластика с использованием микрохирургической техники | 110 000 | эпидуральная анестезия |
| Подвздошно-бедренное шунтирование | 110 000 | Эпидуральная анестезия |
| Бедренно-подколенное проксимальное шунтирование | 110 000 | Эпидуральная анестезия |
| Профундопластика | 66 000 | |
| Операции на артериях ниже колена | ||
| Бедренно-дистально-подколенное шунтирование in situ | 121 000 | Эпидуральная анестезия |
| Забор и создание аутовенозного трансплантата (вне зоны оперируемой конечности)+к стоимости операции | 33000 | Эпидуральная анестезия |
| Создание композитного шунта (из нескольких участков аутовен, с использованием вено-венозных анастомозов, либо конусного протеза PTFE с веной)+к стоимости операции | 55000 | Эпидуральная анестезия |
| Открытая или полузакрытая эндартерэктомия и пластика артерии на протяжении менее 10 см | 44000 | Эпидуральная анестезия |
| Открытая или полузакрытая эндартерэктомия с пластикой на протяжении свыше 10 см | 55000 | Эпидуральная анестезия |
| Микрохирургическое тибиоперонеальное шунтирование | 132 000 | Эпидуральная анестезия |
| Микрохирургическое тибиальное шунтирование в пределах голени (двойное) | 145 200 (181 500) | Эпидуральная анестезия |
| Микрохирургическая реваскуляризация стопы | 181 500 | Эпидуральная анестезия |
| Микрохирургическое малоберцовое шунтирование | 181 500 | Эпидуральная анестезия |
| Операции на сонных, позвоночных и внутричерепных артериях | ||
| Каротидная эндартерэктомия с временным шунтом | 143000 | Общий наркоз |
| Операция при патологической извитости сонных артерий | 121000 | Местная анестезия+седация |
| Операции на I отделе позвоночной артерии | 126500 | Общий наркоз |
| Операции на III отделе позвоночной артерии | 165000 | Общий наркоз |
| Сонно-подключичное шунтирование | 121000 | Общий наркоз |
| Операции при синдроме выхода из грудной клетки | 110 000 | Общий наркоз |
| Удаление шейного ребра | 132000 | Общий наркоз |
| Экстраинтракраниальный микроанастомоз | 220000 | Общий наркоз |
| Прочие операции | ||
| Скелетирование артерий при болезни Паркса — Вебера | 110000 | Эпидуральная анестезия |
| Диагностическая ревизия артерий | 33 000 | Эпидуральная анестезия |
| Формирование нативной артериовенозной фистулы | 33 000 | Эпидуральная анестезия |
| Тромбэмболэктомия | 66000 | Эпидуральная анестезия |
| Профундопластика | 66000 | эпидуральная анестезия |
Стоимость ангиопластики и стентирования периферических артерий
| Название вмешательства | Стоимость в рублях |
| Удаление тромба из артерии по технологии Rotarex Straub | 165 000 |
| Ангиопластика одной артерии (с использованием одного баллона) | 88 000 |
| Имплантация стент-графта в подвздошную или поверхностную бедренную артерию | 220 000 |
| Установка одного стента | 110 000 |
| Реканализация окклюзий артерий голени с использованием специального катетера для поддержки | 55 000 |
| Ангиопластика артерий стопы и подошвенной дуги с использованием ретроградного доступа | 165 000 |
| Имплантация несъемного кава-фильтра | 88 000 |
Вмешательства на сонных артериях |
|
| Установка специального стента во внутреннюю сонную артерию | 110 000 |
| Установка специальной ловушки для внутренней сонной артерии | 110 000 |
| Стентирование внутримозговой части внутренней сонной артерии | 165 000 |
| Ангиопластика внутренней сонной артерии одним специальным баллоном | 88 000 |
Стоимость пластических операций и ампутаций
| Микрохирургическая трансплантация кожно-мышечных лоскутов | 200000 |
| Микрохирургическая островковая пластика тканевых дефектов | 150000 |
| Ампутация бедра | 50000 |
| Костно-пластическая ампутация бедра по Гритти | 60000 |
| Фасциопластическая ампутация голени | 50000 |
| Костнопластическая ампутация голени по Пирогову | 60000 |
| Реампутация голени, формирование культи | 50000 |
| Резекция стопы (в том числе вскрытие диабетической флегмоны) | 50000 |
| Ампутация пальца | 8000 |
| Некрэктомия поверхностных тканей 1% поверхности тела | 6000 |
| Кожная пластика расщепленным кожным лоскутом 1% | 8000 |
| Реконструктивно пластическая операция 1 категории сложности — иссечение язв и ран с закрытием местными тканями без мобилизации. | 20000 |
| Реконструктивно-пластическая операция 2 категории сложности — пластика кожными лоскутами с мобилизацией | 30000 |
| Реконструктивно-пластическая операция 3 категории сложности использование мышечных лоскутов и резекции костей при сложных ранах голени | 50000 |
| Реконструктивно — пластическая операция 4 категории сложности (пластика опорных поверхностей стопы местными тканями) | 70000 |
| Реконструктивная пластика опорных поверхностей стопы с использованием перемещенных кожно-мышечных лоскутов и костных вмешательств | 150000 |
Стоимость лечения в стационаре
Название услуги
Стоимость в рублях
Лечение в системе ОМС
В 2017 году наша клиника получила некоторый объем финансирования за счет средств ОМС на лечение сужений артерий. Это позволяет проводить отдельные сосудистые операции БЕСПЛАТНО для пациентов.
Перечень операций выполняемых в нашей клинике по полису ОМС:
- Стентирование сонных артерий
- Ангиопластика и стентирование артерий нижних конечностей.
- Ангиопластика артерий голени
Срок госпитализации 4 койко-дня. Для того, чтобы воспользоваться лечением по полису ОМС вам надо получить направление в своей поликлинике по форме 057/у на лечение в ООО "Клиника инновационной хирургии, сдать необходимые анализы и записаться на прием к нашим специалистам.
Дополнительное лечение в объеме резекции некрозов, реконструктивно-пластических операций и шунтирование проводятся только на платной основе.
В 2017 году наша клиника получила объемы высоко-технологичной медицинской помощи по эндоваскулярной хирургии при остром коронарном синдроме. По инфаркту и нестабильной стенокардии мы работаем круглосуточно, 7 дней в неделю.
Уточнить возможность лечения по ОМС можно во время консультации у нашего специалиста в Клинике инновационной хирургии г. Клин или в Инновационном сосудистом центре в г.Москва. Консультация и обследование платные.
Шунтирование сосудов нижних конечностей – хирургическое лечение с целью восстановления кровоснабжения в обход пораженного участка сосуда с помощью создания искусственного анастомоза. Операция проводится в случае стеноза или облитерации сосуда. Шунтирование проводят при облитерации коронарных артерий сердца, но данная операция показана и для лечения ног.
Шунтирование вен назначают тогда, когда лечение с помощью консервативных методов не дало положительного результата и есть риск ампутации конечности. Операцию назначают при:
- Атеросклерозе нижних сосудов на ногах.
- Варикозе вен нижних конечностей.
- Эндартериите.
- Некрозе нижней конечности.
- Аневризме.
- Других патологиях сосудов, когда отмечается стеноз и ишемия тканей и др.
Шунтирование применяется в крайнем случае, только если операция по установке стента или ангиопластика по каким-либо причинам выполнены быть не могут. У пациентов с критической ишемией (нарушением питания тканей в результате недостаточного кровоснабжения) нижних конечностей, как правило, в течение полугода после начала заболевания назначается проведение ампутации ноги. Шунтирование, проведенное пациентам с критической ишемией, позволяет в 90% сохранить больному конечность.
В случае тяжелой формы поражения сосудов, угрожающей жизни пациента, вначале предлагают ангиопластику артерий или вен голени. Эндартериит с гангреной ноги – веская причина для проведения микрохирургического шунтирования. При сегментарном сужении вен показано эндоваскулярное лечение – стентирование, баллонная дилятация или ангиопластика. Проведение операции шунтирования вен используют, чтобы спасти нижнюю конечность, в случае неэффективного лечения.
При стенозе сосуда большой протяженности шунтирование сочетают с проведением протезирования пораженного участка вены или артерии аллопротезом, тромбэндартерэктомией. В случаях множественного атеросклероза сосудов нижних конечностей сочетают проведение шунтирования вен с дилатацией хода. Если питание тканей нарушено длительное время и есть некроз или трофические язвы, то после восстановления кровотока требуется сделать еще операцию по удалению омертвевших тканей и закрытия трофических язв кожным лоскутом. Проведение такой операции может осуществляться в тот же день, что и шунтирование, или через некоторый промежуток времени.
Если некротические изменения затрагивают обширные участки мягких тканей ноги и восстановление кровотока невозможно, то, чтобы спасти жизнь пациента, показана ампутация конечности. Применение шунтирования вен или других методов оперативного лечения и восстановления кровоснабжения нижних конечностей назначают после тщательного исследования состояния нижних сосудов.
Операции шунтирования сосудов нижних конечностей требуют предоперационной подготовки. Врач назначает проведение аппаратного исследования состояния кровеносной системы ног. Это:
- Дуплексное сканирование для осмотра полости вен и артерий, определения локализации закупоренных участков нижних сосудов и скорости гемотока.
- Магнитно-резонансная ангиография для проведения послойного обследования нижних вен.
- Ангиография – проводится оценка характера сужения вены и обнаруживается закупоренный участок по ходу сосуда.
Шунтирование сосудов сердца предваряется УЗИ органа и коронографией. Увеличение риска послеоперационных осложнений лечения наблюдается у пациентов с:
- Ожирением.
- Высоким кровяным давлением.
- Высоким уровнем холестерина.
- Патологией сердца, легких, почек.
- Сахарным диабетом и т. д.
В таком случае проведение шунтирования вен оправдано только при наличии угрозы для жизни пациента. Проведение тщательной оценки состояния подкожных вен обусловлено тем, что от этого зависит период функционирования шунта и эффективность лечения. Шунтирование искусственным протезом делают в крайнем случае, так как отзывы хирургов свидетельствуют о том, что половина вен закупоривается через 3 года.
Увеличение риска послеоперационных осложнений лечения наблюдается у пациентов с ожирением.
В зависимости от локализации сужения участка по ходу сосуда нижней конечности лечение проводится с применением различных вариантов шунтирования:
- Бедренно-берцовое – при проведении операции используют большую подкожную вену больного, которую оставляют на месте. Такой вид шунтирования сосудов ног – основной метод лечения тяжелой степени ишемии. В начальной стадии гангрены, сопровождающейся некрозом пальцев ноги и трофическими язвами, в 90% удается спасти конечность. Если большая подкожная вена не пригодна, то для лечения берут фрагмент вен ног или рук.
- Шунтирование малоберцовой артерии проводится в случае, если объема крови не достаточно для функционирования шунта. Для успеха лечения необходимо точно установить объем гемотока. Для снижения давления в артерии применяют наложение коллатералей с венами, расположенными по ходу сосуда, на некотором расстоянии от анастомоза.
- Многоэтажные шунты – при отсутствии проходимости артерии на голени ноги могут делаться несколько анастомозов к участкам артерии с сохранившимся гемотоком. Чтобы избежать перегрузки шунтов, используется определенное количество разгрузочных фистул по ходу сосуда.
Микрохирургическое шунтирование на стопе конечности показано при полном закрытии всех артерий голени. Чтобы спасти ногу, лечение проводится с наложением микрошунтов по ходу сосудов стопы. Такая операция стала возможна с применением в хирургии операционного микроскопа при 25-50-кратном увеличении.
Как делают шунтирование? Как правило, шунтирование проводится под эпидуральной анестезией. Это помогает не только избежать осложнений, вызванных общей анестезией, но и исключить болевые ощущения в послеоперационный период. Сначала делают небольшие разрезы по ходу сосуда в паху, на голени или стопе нижней конечности. После проведения оценки состояния артерии готовят шунт. Через отверстия по ходу вены на голени и бедре вытаскивают сосуд. Шунтирование сосудов нижней конечности начинают с соединения вены с артерией бедра. С помощью вальвулота производят удаление клапанов вены и пускают кровь по большой подкожной вене в латеральную часть ноги.
Длительность операции зависит от сложности и обширности поражения сосудов.
Проводя аппаратное исследование, врач находит места, где кровь по шунту оттекает в боковые ответвления, и через небольшие разрезы по ходу ветвей, проводит их перевязку. Затем под микроскопом пришивают вену к артерии в области голени и стопы, запускают кровоток и оценивают его с помощью УЗИ. Если гемоток в вене в норме, то разрезы зашивают. Если результат неудовлетворительный, то делается повторный аппаратный анализ и пластика сосуда латеральнее шунта. Длительность операции зависит от сложности и обширности поражения сосудов.
Отзывы об уровне проведения лечения методом шунтирования нижних конечностей очень разные. Много пациентов жалуются на послеоперационные осложнения, высокую стоимость, длительное лечение. Хорошие отзывы о лечении и специалистах в Москве, где отмечают высокий профессионализм и эффективность проведенного лечения. Хвалят и Витебск, где сердечный шунт устанавливают на работающем сердце.
После того как операция успешно завершена, больной находится под наблюдением в отделении еще 10 дней. Уже на следующие сутки пациент может стоять и самостоятельно передвигаться. Через неделю снимают швы по ходу вены на нижней конечности. Если нет осложнений, то лечение в стационаре длится всего 2 недели, после чего больной выписывается.
В послеоперационный период больной должен придерживаться определенных правил. Большое значение для успешного и скорого восстановления имеет соблюдение больным специальной диеты:
- При употреблении блюд с высоким содержанием жиров, углеводов шунты могут быстро закупориться. Поэтому стоит их исключить из меню.
- В рационе главное место должны занимать продукты с высоким содержанием полинасыщенных кислот, препятствующих отложению холестерина.
- Рекомендуется приготовление пищи на пару с низким содержанием соли.
Рецепты на каждый день можно уточнить у специалистов-диетологов. Многие пациенты спрашивают: «Как долго должна продолжаться диета, чтобы закрепить пройденное лечение?» Сбалансированное питание должно стать нормой жизни. Чтобы жить без риска рецидива заболевания, необходимо профилактическое лечение – медикаментозное и физиотерапевтическое. Показаны дозированные физические нагрузки, ЛФК, отказ от курения и алкоголя.
И, конечно, больных интересует вопрос – сколько стоит операция шунтирования сосудов ног. Цена зависит не только от региона, престижности клиники, но и от сложности и вида операции. Например, цена бедренно-берцового шунтирования ног в Москве начинается с 20716 р. Цена операции на артерии голени ноги – от 130000 р., на артерии стопы ноги – от 165000 р., на подколенной артерии ноги – 120000 р. и т. д.
Однако, несмотря на такую высокую стоимость, лечение шунтированием вен, по мнению специалистов, и соблюдение правил в постреабилитационный период значительно повышают шансы на выздоровление.
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