Surgical revascularization techniques for diabetic foot

Abstract

a b s t r a c tDiabetes is an important risk factor for atherosclerosis. The diabetic foot is characterized by the presence of arteriopathy and neuropathy. The vascular damage includes non-occlusive microangiopathy and macroangiopathy. Diabetic foot wounds are responsible for 5e10% of the cases of major or minor amputations. In fact, the risk of amputation of the lower limbs is 15e20% higher in diabetic populations than in the general population. The University of Texas classification is the reference classification for diabetic wounds. It distinguishes non-ischemic wounds from ischemic wounds which are associated with a higher rate of amputation. The first principles of treatment are the control of pain of an eventual infection. When ischemia is diagnosed, restoration of pulsatile blood flow by revascularization may be considered for salvaging the limb. The treatment options are angioplasty with or without stenting and surgical bypass or hybrid procedures combining the two. Distal reconstructions with anastomosis to the leg or pedal arteries have satisfactory limb-salvage rates. Subintimal angioplasty is a more recent endovascular technique. It could be suggested for elderly patients who are believed to be unsuitable candidates for a conventional bypass or angioplasty. The current article would focus on the various revascularization procedures.

Long-term outcomes of infrainguinal bypass surgery for patients with diabetes mellitus and tissue loss

“…Although successful revascularization had been performed, and the grafts remained patent; major amputation was performed because of severe soft tissue infection. Therefore, not only revascularization but also infection control measures, including drainage and minor amputation, are important procedures for the diabetic foot [ 19 ].…”

Formulation of Guava (Psidium Guajava) and Purple Sweet Potato (Ipomoea Batatas L. Poir) Velva With Low Calorie Sweeter as an Alternative of Functional Food

“…Purple sweet potato is a type of tuber that contains food fiber and a low glycemic index (GI) value thereby giving added value to this commodity as functional food. The content of anthocyanin in purple sweet potato is quite high, as reported by Kumalaningsih the content reaches 519 mg / 100g weight wet so that it has great potential as a source of antioxidants for human health [3], [4]. Furthermore, Shahidi and Naczk that natural antioxidant compounds are able to slow down, delay, or prevent oxidation.…”

A diabeteses láb ischaemiás eredete. Epidemiológia, a diagnózis nehézségei, prevenciós és revascularisatiós lehetőségek

“…Ha az adott ér kiáramlási pályája megtartott [36], hosszú, ízületet is áthi-daló, akár bokáig tartó bypassműtét is végezhető [31]. Nyitott talpi ív esetén pedalis szintű áthidalás is lehetséges [37]. Térd alatti rekonstrukcióhoz kizárólag csak saját véna, illetve homológ graft alkalmazható.…”

“…Több szintet érintő -azaz femoralis, poplitealis és/vagy cruralis -érterületek elzáródásakor hibrid megoldások alkalmazhatók [36], vagyis a centrális érszakaszon vénás bypass és egy ülésben intraoperatív PTA a kiáramlási pálya megnyitására, javítá-sára vagy femoralis superficialis PTA és popliteocruralis vénás bypass. A megfelelő módszer kiválasztását a vascularis státuszon túl a beteg teherbírása, a sebészi team gyakorlata, a felhasználandó véna minősége, a sebész radioló-giai gyakorlata vagy a társszakmák segítsége is döntően befolyásolja [37].…”