Wound-directed revascularisation in the Diabetic Foot patients
DOI:
https://doi.org/10.12775/JEHS.2021.11.10.027Keywords
Diabetic foot, foot lesions, revascularization, angioplastyAbstract
Introduction: Peripheral arterial diseases in patients with diabetic foot have significant features in pathogenesis, manifestations and course compared with peripheral arterial disease. These features require different approaches to treatment and the the angiosome theory can help increase the effectiveness of revascularization in patients with diabetic foot.
The aim: Analyse the results of revascularisation of lower extremity arteries in the patients with ischemic diabetic foot ulcers according to the angiosome theory.
Materials and metods: We analysed 98 revascularisations of arteries of 77 lower limbs in 74 ischemic diabetic foot patients for the period from 2017 to 2021. Angioplasties were performed in 71 cases (72,5%), open operations – in 21 (21,4%), hybrid operations – 6 (6,1%). According to angiosome theory we divided the revascularizations into two groups. І group – direct revascularizations (DR) – 57 cases, ІІ group – indirect revascurizations (IR) – 21 cases.
Results: Within 6 months foot lesions healing fixed in І group (DR) - 81.7%, in ІІ group (IR) – 78.6%. Major amputations were the consequences of 17,1% revascularizations: DR group – 12,4%, IR group – 33,3%. Functional capacity of the lower extremity within one year was saved in 79,3% in DR group and in 57,9% in IR group. Repeated revascularizations accounted for 21,4% of cases: in DR group – 20,5%, in IR group – 25%.
The results of the statistical analysis revealed the dependence of the risk of amputation on adherence to angiosome theory during revascularization.
Conclusions: Angiosome-targeted revascularization in the area of foot lesions increases efficiency of the revascularization and improves immediate and long-term treatment results.
References
Gojka R. WHO Global report on diabetes: A summary. Int J Noncommun Dis Jan 2016; 1 (1): 3-8. doi:10.4103/2468-8827.184853. https://www.ijncd.org/article.asp?issn=2468-8827
National diabetes audit executive summary 2009-10. The NHS Information Centre 2011 https://digital.nhs.uk/data-and-information/ publications/ statistical/ national-diabetes-audit/national-diabetes-audit-2009-10
Spoden M, Nimptsch U, Mansky T. Amputation rates of the lower limb by amputation level - observational study using German national hospital discharge data from 2005 to 2015. BMC Health Serv Res. 2019 Jan 6; 19(1): 8. doi: 10.1186/s12913-018-3759-5..PMID: 30612550. https://pubmed.ncbi.nlm.nih.gov/30612550/
Ziegler-Graham K, MacKenzie E, Ephraim P. et al. Estimating the Prevalence of Limb Loss in the United States: 2005 to 2050. Arch Phys Med Rehabil. 2008 Mar; 89(3): 422-9. doi: 10.1016/j.apmr.2007.11.005. https://pubmed.ncbi.nlm.nih.gov/18295618/
Carmona G, Hoffmeyer P, Herrmann F. et al. Major lower limb amputations in the elderly observed over ten years: the role of diabetes and peripheral arterial disease. Diabetes Metab. 2005; 31(5): 449–454. PMID: 16357788 doi: 10.1016/s1262-3636(07)70215-x. https://pubmed.ncbi.nlm.nih.gov/16357788/
Thorud JC, Plemmons B, Buckley CJ et al. Mortality After Nontraumatic Major Amputation Among Patients With Diabetes and Peripheral Vascular Disease: A Systematic Review. J Foot Ankle Surg. 2016; 55(3): 591-9 PMID: 26898398 doi: 10.1053/j.jfas.2016.01.012. https://pubmed.ncbi.nlm.nih.gov/26898398/
Lepäntalo M, Mätzke S. Outcome of unreconstructed chronic critical leg ischaemia. Eur J Vasc Endovasc Surg. 1996; 11(2):153-7. PMID: 8616645 DOI: 10.1016/s1078-5884(96)80044-x. https://pubmed.ncbi.nlm.nih.gov/8616645/
Londero L, Høgh A, Houlind K. et al. Prevalence of Major Lower Limb Amputation Across Denmark and Its Relationship with Revascularization, Demography and Disease Risk Factors. Eur J Vasc Endovasc Surg. 2019; 57(1):111-120. doi: https://doi.org/10.1016/j.ejvs.2016.07.059. https://pubmed.ncbi.nlm.nih.gov/30293885/
Ebskov L, Schroeder T, Holstein P. Epidemiology of leg amputation: the influence of vascular surgery. Br J Surg. 1994 Nov; 81(11):1600-3. PMID: 7827881 DOI: 10.1002/bjs.1800811111 https://pubmed.ncbi.nlm.nih.gov/7827881/
Prompers L, Huijberts M, Apelqvist J et al. Delivery of care to diabetic patients with foot ulcers in daily practice: results of the Eurodiale Study, a prospective cohort study. Diabetic Medicine Volume 25, Issue 6 June 2008 Pages 700-707 https://doi.org/10.1111/j.1464-5491.2008.02445.x
Conte MS, Bradbury AW, Kohl Ph. et al. GVG Writing Group for the Joint Guidelines of the Society for Vascular Surgery (SVS), European Society for Vascular Surgery (ESVS), and World Federation of Vascular Societies (WFVS). Global Vascular Guidelines on the Management of Chronic Limb-Threating Ichemia Eur J Vasc Endovasc Surg. 2019; 58(1S):S1-S109. doi: 10.1016/j.ejvs.2019.05.006. Epub 2019 Jun 8. https://pubmed.ncbi.nlm.nih.gov/31182334/
Taylor GI The angiosomes of the body and their supply to perforator flaps. Clin Plast Surg. 2003; 30(3): 331-42, v. PMID: 12916590. doi: 10.1016/s0094-1298(03)00034-8. https://pubmed.ncbi.nlm.nih.gov/12916590/
Manzi M, Cester G, Palena LM et al. Vascular imaging of the foot: the first step toward endovascular recanalization. Radiographics. 2011; 31(6):1623-36. doi: 10.1148/rg.316115511. https://pubmed.ncbi.nlm.nih.gov/21997985/
Nicolaas C. Schaper (chair), Jaap J. Van Netten, Jan Apelqvist et al. IWGDF Guidelines on the prevention and management of diabetic foot disease Diabetes Metab Res Rev. 2020; 36 (1): e3266. doi: 10.1002/dmrr.3266. https://pubmed.ncbi.nlm.nih.gov/32176447/
Marco Manzi, Luis M. Palena. Treating Calf and Pedal Vessel Disease: The Extremes of Intervention Semin Intervent Radiol. 2014;31(4):313-9. doi: 10.1055/s-0034-1393967. PMID: 25435656 PMCID:PMC4232433. https://pubmed.ncbi.nlm.nih.gov/25435656/
Huang TY, Huang TS, Wang YC et al. Direct Revascularization With the Angiosome Concept for Lower Limb Ischemia: A Systematic Review and Meta-Analysis Medicine (Baltimore). 2015; 94(34):e1427. doi: 10.1097/MD.0000000000001427. https://pubmed.ncbi.nlm.nih.gov/26313796/
Jongsma H., Bekken J.A., Akkersdijk G.P. et al. Angiosome-directed revascularization in patients with critical limb ischemia J Vasc Surg. 2017; 65(4):1208-1219. doi: 10.1016/j.jvs.2016.10.100. https://pubmed.ncbi.nlm.nih.gov/28342514/
Tefera G, Hoch J, Turnipseed WD. Limb-salvage angioplasty in vascular surgery practice. J Vasc Surg. 2005;41(6):988-93. PMID: 15944598 DOI: 10.1016/j.jvs.2005.03.018. https://pubmed.ncbi.nlm.nih.gov/15944598/
Osamu Iida, Mitsuyoshi Takahara,Yoshimitsu Soga et al. Three-Year Outcomes of Surgical Versus Endovascular Revascularization for Critical Limb Ischemia The SPINACH Study (Surgical Reconstruction Versus Peripheral Intervention in Patients With Critical Limb Ischemia) on behalf of the SPINACH Investigators (Circ Cardiovasc Interv. 2017;10:e005531. DOI 10.1161/CIRCINTERVENTIONS.117.005531.) https://pubmed.ncbi.nlm.nih.gov/29246911/
Stavroulakis K, Borowski M, Torsello G. One-Year Results of First-Line Treatment Strategies in Patients With Critical Limb Ischemia (CRITISCH Registry). J Endovasc Ther. 2018; 25(3):320-329. doi: 10.1177/1526602818771383. https://pubmed.ncbi.nlm.nih.gov/29968501/
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