Treatment of lower limb ischaemia in patients with diabetes

Abstract

Diabetic chronic limb‐threatening ischaemia is a challenging clinical problem with patients at high risk of diabetic foot ulceration (DFU) and limb loss. Patients often remain asymptomatic even in the presence of severe pedal ischaemia until first presenting with tissue loss such as DFU or frank gangrene. Limb salvage units should have the facilities and expertise to provide multidisciplinary team‐based holistic care through best medical therapy, rapid diagnosis, prompt revascularisation with endovascular or open surgical techniques and expert wound management. Endovascular revascularisation has become the first line strategy in contemporary clinical practice because of similar outcomes in wound healing and amputation rates in most patients when compared with open surgery. The primary goal is restoration of pulsatile in‐line blood flow to the ankle or foot, with an angiosome‐directed approach possibly achieving superior outcomes especially in diabetics with poor collaterals. A comprehensive overview of conventional endovascular techniques (such as antegrade true lumen and subintimal approaches), advanced techniques for complex disease (such as retrograde subintimal and pedal‐plantar loop approaches or even deep venous arterialisation) and the various treatment options are described. Diabetic limb salvage rates can be excellent with suitable multidisciplinary expertise and care.

Exosome/metformin-loaded self-healing conductive hydrogel rescues microvascular dysfunction and promotes chronic diabetic wound healing by inhibiting mitochondrial fission

“…Blood vessels provide nutrition and oxygen to the skin and are critical for wound healing. Hence, treatments for chronic wounds involve strategies to improve endothelial dysfunction, reduce inflammatory responses, and promote wound revascularization [ 49 , 50 ] CD31 is a marker of wound neovascularization, and aSMA is a marker of mature vessels [ [51] , [52] , [53] , [54] , [55] ] aSMA/CD31 dual fluorescence assay revealed the highest density and quantity of blood vessels with large lumens and intact structures in the PEG/Ag/CNT-M + E group 7 days after injury compared with the other groups ( Fig. 5 B,D,5E).…”

Exosomes Derived from Adipose Mesenchymal Stem Cells Promote Diabetic Chronic Wound Healing through SIRT3/SOD2

“…New blood vessels promote wound healing by transporting nutrients, oxygen, and growth factors to the injured site [ 25 ]. However, the high-glucose environment in diabetic patients leads to dysfunction in vascular endothelial cells, resulting in reduced angiogenesis, which is characterized by reduced blood vessel formation and decreased capillary density [ 26 ]. Our previous study has shown that under high-glucose conditions, in vitro HUVECs proliferation and migration were inhibited, and angiogenesis was impaired [ 27 ].…”

Evaluation of Short-Term Insulin Pump for Treatment of Patients with Type 2 Diabetes Mellitus Complicated with Lower Extremity Arterial Disease in Endocrinology by Ultrasonography

“…Limb ischemia caused by diabetic LEAD is not only a factor causing the occurrence of diabetic foot but also an important cause of recurrent and prolonged diabetic foot ulcers [ 16 ]. LEAD in patients with DM has an insidious onset and usually atypical or even asymptomatic clinical symptoms, which makes DM patients and doctors often ignore the presence of LEAD, which makes it difficult to correctly diagnose and evaluate diabetic LEAD [ 17 ].…”