The Role of Endovascular Procedure for Peripheral Arterial Disease in Diabetic Patients With Chronic Limb-Threatening Ischemia

Santosa, Yudistira P.; Harca, Azizah Dhena; Sukmaja, Edwin; Yuwono, Angelina

doi:10.7759/cureus.23857

Cited by 3 publications

(4 citation statements)

References 13 publications

(16 reference statements)

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“…A small percentage of foot ulcers in patients with peripheral arterial disease are purely ischemic, and they are usually painful, but the majority of foot ulcers are either purely neuropathic or neuro-ischemic (that is, caused by combined neuropathy and ischemia), and they can often be asymptomatic [ 8 ]. Notably, the indicated factors can lead to foot ulcers of differing severity, possibly reaching a remarkable size and depth, as shown by images reported in several studies [ 9 , 10 , 11 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Artificial Intelligence Methodologies Applied to Technologies for Screening, Diagnosis and Care of the Diabetic Foot: A Narrative Review

et al. 2022

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Diabetic foot syndrome is a multifactorial pathology with at least three main etiological factors, i.e., peripheral neuropathy, peripheral arterial disease, and infection. In addition to complexity, another distinctive trait of diabetic foot syndrome is its insidiousness, due to a frequent lack of early symptoms. In recent years, it has become clear that the prevalence of diabetic foot syndrome is increasing, and it is among the diabetes complications with a stronger impact on patient’s quality of life. Considering the complex nature of this syndrome, artificial intelligence (AI) methodologies appear adequate to address aspects such as timely screening for the identification of the risk for foot ulcers (or, even worse, for amputation), based on appropriate sensor technologies. In this review, we summarize the main findings of the pertinent studies in the field, paying attention to both the AI-based methodological aspects and the main physiological/clinical study outcomes. The analyzed studies show that AI application to data derived by different technologies provides promising results, but in our opinion future studies may benefit from inclusion of quantitative measures based on simple sensors, which are still scarcely exploited.

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Section: Introductionmentioning

confidence: 99%

Artificial Intelligence Methodologies Applied to Technologies for Screening, Diagnosis and Care of the Diabetic Foot: A Narrative Review

et al. 2022

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“…caused by inappropriate shoes or by an acute injury, can result in a chronic ulcer [10,11]. The foot ulcers observed under such conditions can present with differing severity and may reach a remarkable size and depth [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Diabetic Foot Syndrome By Means of Hyaluronidase Infusion Therapy – Single Patient Case Report

Pfutzner,

Segiet,

Hanna

et al. 2023

Med Clin Case Rep

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Background: Diabetic foot syndrome (DFS) is one of the most severe secondary complications of diabetes mellitus. It is currently treated with improvement and maintenance of good glycemic control, pain drugs, antibiotics, and drugs and surgical measures to improve the vascular blood flow into the legs. In late stages, foot amputation (in part or total) is the only means to safe the patient’s life. Case Report: A 56-year-old woman with type 1 diabetes for more than 40 years, suffered from diabetic foot syndrome with complete closure of the arteria fibularis and a non-healing foot ulcer at the left leg. The need for lower ankle amputation was already determined. We tried to improve the vascular situation by means of a series of intravenous hyaluronidase infusions over a period of three weeks. An immediate improvement of the general condition was observed. The ulcer healed completely within 8 weeks, and a re-opening of the previously closed vessel as well as further additional collateral blood-flow into the left foot could be determined by means of an angiogram six months later. Discussion: The observed beneficial impact of intravenous hyaluronidase treatment on atherosclerotic lesions can be explained by the molecular action of the enzyme on the glycocalix, the extracellular hyaluronan layer that separates the endothelial cells from the blood stream. Successful treatment of DFS with hyaluronidase infusions has been reported already 50 years ago but research on this topic ceased, when stents and other apparently more compelling vascular treatment methods were detected. Conclusions: In a severe case of DFS, we were able to re-open a critical arterial vessel and improve the entire vascular blood flow by means of intravenous hyaluronidase infusions. Clinical studies are required to confirm the value of hyaluronidase infusions as treatment alternative to amputation for DFS.

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“…Based on the TASC II classification, A and B class lesions are generally amenable to primary endovascular interventions, whereas open surgery is considered for C-level lesions and recommended for D-level lesions (3). In recent years, mounting evidence and reports have emerged regarding the feasibility of endovascular therapy in complex scenarios, including chronic total occlusions, multiple lesions, long lesions, and TASC II class C and D lesions [4][5][6]. However, further evidence is required to establish the feasibility and efficacy of endovascular treatment as a standardized approach for this specific patient population [5,6].…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, mounting evidence and reports have emerged regarding the feasibility of endovascular therapy in complex scenarios, including chronic total occlusions, multiple lesions, long lesions, and TASC II class C and D lesions [4][5][6]. However, further evidence is required to establish the feasibility and efficacy of endovascular treatment as a standardized approach for this specific patient population [5,6].…”

Section: Introductionmentioning

confidence: 99%

Endovascular revascularization of challenging anatomical lesions: Revascularization in TASC-II C and D classes: A single-centre retrospective report

Kaya,

Bulut,

Kocaoglu

et al. 2023

Turk J Vasc Surg

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Aim: Peripheral arterial disease (PAD) is a prevalent condition that significantly impacts quality of life and that can lead to limb amputation and thromboembolic events. Treatment options for PAD include endovascular and open surgical interventions, with the choice depending on the Trans-Atlantic inter-society consensus II (TASC II) classification. Recent evidence suggests that endovascular therapy may be feasible for complex PAD lesions, but further research is needed. Material and Methods: This retrospective cohort study included 50 patients with TASC II class C and D lesions. The procedures were conducted using a state-of-the-art angiography system, and patients received appropriate antiplatelet therapy and heparin during the intervention. Data collection was performed following ethical considerations and standardization protocols. Results: This study involved 50 patients with peripheral arterial disease, characterized by an average age of 65.0 years and a prevalence of comorbidities such as coronary artery disease, hypertension, type 2 diabetes mellitus, and tobacco use. The majority of patients presented with claudication and had lesions primarily in the femoropopliteal region. The procedures performed, primarily using drug-coated balloons, resulted in high technical success rates and favorable outcomes at 30 days, with a slight decline in primary patency rates at 6 months. Some patients required readmission due to cardiac reasons, and a small portion necessitated open surgical revascularization. Conclusion: Our findings support the use of endovascular revascularization as a safe and effective option for patients with complex lesions. Further research is needed to address challenges related to dissection and optimize outcomes in this patient population. This study contributes to the growing understanding of treatment approaches for peripheral artery disease and highlights the potential benefits of endovascular therapy.

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The Role of Endovascular Procedure for Peripheral Arterial Disease in Diabetic Patients With Chronic Limb-Threatening Ischemia

Cited by 3 publications

References 13 publications

Artificial Intelligence Methodologies Applied to Technologies for Screening, Diagnosis and Care of the Diabetic Foot: A Narrative Review

Artificial Intelligence Methodologies Applied to Technologies for Screening, Diagnosis and Care of the Diabetic Foot: A Narrative Review

Treatment of Diabetic Foot Syndrome By Means of Hyaluronidase Infusion Therapy – Single Patient Case Report

Endovascular revascularization of challenging anatomical lesions: Revascularization in TASC-II C and D classes: A single-centre retrospective report

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