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Diabetic foot revascularisation

Michael Edmonds, José Luis Lázaro-Martínez, Jesus Manuel Alfayate-García, Jacques Martini, Jean-Michel Petit, Gerry Rayman, Ralf Lobmann, Luigi Uccioli, Anne Sauvadet, Serge Bohbot, Jean-Charles Kerihuel, Alberto Piaggesi
BACKGROUND: Diabetic foot ulcers are serious and challenging wounds associated with high risk of infection and lower-limb amputation. Ulcers are deemed neuroischaemic if peripheral neuropathy and peripheral artery disease are both present. No satisfactory treatment for neuroischaemic ulcers currently exists, and no evidence supports one particular dressing. We aimed to assess the effect of a sucrose octasulfate dressing versus a control dressing on wound closure in patients with neuroischaemic diabetic foot ulcers...
March 2018: Lancet Diabetes & Endocrinology
Kjersti Wendt, Ronny Kristiansen, Kirsten Krohg-Sørensen, Fredrik Alexander Gregersen, Erik Fosse
OBJECTIVE: The numbers of lower extremity revascularisations and amputations are insufficiently reported in Norway. To support future policy decisions regarding the provision of vascular treatment, knowledge of such trends is important. METHODS: This retrospective cross-sectional study from 2001 to 2014 used data from the Norwegian Patient Registry. The revascularisation treatments were categorised in multilevel, aortoiliac, femoral to popliteal and popliteal to foot levels and sorted as open, endovascular and hybrid...
November 14, 2017: BMJ Open
J G van Baal, W B Aan de Stegge, N C Schaper
The history of two patients (66- and 53-year-old males) with diabetes and peripheral neuropathy illustrates the variety of clinical presentations and pitfalls in treatment of diabetic foot ulcers. Peripheral arterial disease and mechanical stress as a consequence of peripheral neuropathy are important risk factors for developing an ulcer and eventually loss of a limb. Revascularisation of the limb should be considered in the presence of critical limb ischaemia or in the presence of mild to severe ischaemia in combination with a deep infection...
2017: Nederlands Tijdschrift Voor Geneeskunde
Frances Game, William Jeffcoate, Lise Tarnow, Florence Day, Deborah Fitzsimmons, Judith Jacobsen
BACKGROUND: Diabetic foot ulcers are a common and severe complication of diabetes mellitus. Standard treatment includes debridement, offloading, management of infection and revascularisation where appropriate, although healing times may be long. The LeucoPatch® device is used to generate an autologous platelet-rich fibrin and leucocyte wound dressing produced from the patient's own venous blood by centrifugation, but without the addition of any reagents. The final product comprises a thin, circular patch composed predominantly of fibrin together with living platelets and leucocytes...
October 10, 2017: Trials
Nakabayashi Keisuke, Matsui Akihiro, Hiroshi Ando, Minoru Shimizu
No abstract text is available yet for this article.
July 14, 2017: BMJ Case Reports
Benedictine Y C Khor, Pamela Price
BACKGROUND: Ischaemic ulcerations have been reported to persist and/or deteriorate despite technically successful revascularisations; a higher incidence of which affects patients with diabetes and critical limb ischaemia. In the context of wound healing, it is unclear if applications of the angiosome concept in 'direct revascularisation' (DR) would be able to aid the healing of chronic foot ulcerations better than the current 'best vessel' or 'indirect revascularisation' (IR) strategy in patients with co-morbid diabetes and critical limb ischaemia...
2017: Journal of Foot and Ankle Research
E Lenselink, S Holloway, D Eefting
OBJECTIVE: The aim of this study was to retrospectively measure the outcomes of foot-sparing surgery at one year follow-up for patients with diabetic foot ulcers (DFUs). We assessed wound healing and the need for further surgery in relation to the variables that influence healing. METHOD: Data were retrospectively collected by reviewing the electronic files of patients attending the Wound Expert Clinic (WEC). Outcomes of surgical debridement, toe, ray and transmetatarsal amputations were assessed...
May 2, 2017: Journal of Wound Care
Bettina Hartmann, Christian Fottner, Karin Herrmann, Tobias Limbourg, Matthias M Weber, Karlheinz Beckh
AIMS: A major proportion of patients with diabetic foot syndrome are older than 65 years. Little is known about outcomes of these elderly patients. METHODS: We analysed 245 treatment cases in an observational single-centre study for comorbidities and outcomes over a 6-month period. RESULTS: In all, 122 patients had peripheral arterial disease which was significantly increasing with age (n = 245, df = 1, χ2  = 23.06, p ⩽ 0...
January 2017: Diabetes & Vascular Disease Research
E Andrea Nelson, Alexandra Wright-Hughes, Sarah Brown, Benjamin A Lipsky, Michael Backhouse, Moninder Bhogal, Mwidimi Ndosi, Catherine Reynolds, Gill Sykes, Christopher Dowson, Michael Edmonds, Peter Vowden, Edward B Jude, Tom Dickie, Jane Nixon
BACKGROUND: There is inadequate evidence to advise clinicians on the relative merits of swabbing versus tissue sampling of infected diabetic foot ulcers (DFUs). OBJECTIVES: To determine (1) concordance between culture results from wound swabs and tissue samples from the same ulcer; (2) whether or not differences in bacterial profiles from swabs and tissue samples are clinically relevant; (3) concordance between results from conventional culture versus polymerase chain reaction (PCR); and (4) prognosis for patients with an infected DFU at 12 months' follow-up...
November 2016: Health Technology Assessment: HTA
Naseer Ahmad, G Neil Thomas, Paramjit Gill, Francesco Torella
AIMS: To determine the prevalence of amputation and revascularisation among diabetics and non-diabetics between 2003 and 2013. METHODS: Retrospective analysis of English hospital data with census estimates for population aged 50-84 years. RESULTS: There were 42,294 major and 52,525 minor amputations and 355,545 revascularisations. Major amputation rates fell by 20% (27.7-22.9), with minor amputations (22.9-35.2) and revascularisations (199...
September 2016: Diabetes & Vascular Disease Research
Fabio Fiordaliso, Giacomo Clerici, Serena Maggioni, Maurizio Caminiti, Cinzia Bisighini, Deborah Novelli, Daniela Minnella, Alessandro Corbelli, Riccardo Morisi, Alberto De Iaco, Ezio Faglia
AIMS/HYPOTHESIS: We investigated the significance of microangiopathy in the development of foot ulcer, which is still disputed. METHODS: We assessed microangiopathy by histological analysis of the capillary ultrastructure using transmission electron microscopy and capillary density and arteriolar morphology in paraffin-embedded sections from the skin of type 2 diabetic patients: 30 neuroischaemic patients (Isc) revascularised with peripheral angioplasty and 30 neuropathic patients (Neu) with foot ulcer, compared with ten non-diabetic volunteers...
July 2016: Diabetologia
A J Beaney, I Nunney, C Gooday, K Dhatariya
AIMS: To identify which factors predict the need for minor or major amputation in patients attending a multidisciplinary diabetic foot clinic (DFC). METHODS: A retrospective analysis of patients who attended over a 27 month period were included. Patients had to have attended ≥3 consecutive consultant led clinic appointments within 6 months. Data was collected on HbA1c, clinic attendance, blood pressure, peripheral arterial disease (PAD), and co-morbidities. Patients were followed up for 1 year...
April 2016: Diabetes Research and Clinical Practice
Mendel Baba, Wendy A Davis, Paul E Norman, Timothy M E Davis
BACKGROUND: To determine temporal changes in the prevalence and associates of lower extremity amputation (LEA) complicating type 2 diabetes. METHODS: Baseline data from the longitudinal observational Fremantle Diabetes Study (FDS) relating to LEA and its risk factors collected from 1296 patients recruited to FDS Phase 1 (FDS1) from 1993 to 1996 and from 1509 patients recruited to FDS Phase 2 (FDS2) from 2008 to 2011 were analysed. Multiple logistic regression was used to determine associates of prevalent LEA in individual and pooled phases...
2015: Cardiovascular Diabetology
T Elgzyri, J Larsson, P Nyberg, J Thörne, K-F Eriksson, J Apelqvist
OBJECTIVE: There is limited information regarding new ulceration following the healing of ischaemic foot ulcers in diabetic patients. Our aim is to study new ulcerations in the same foot as the previous ulcer(s) in patients with diabetes and severe peripheral artery disease (PAD). METHOD: Patients with diabetes and severe PAD who healed from previous ulcer(s) (Wagner grade 1-5, at or below the ankle), were recruited for the prospective study from the time of healing of their ulcer...
December 2015: Journal of Wound Care
R J Hinchliffe, J R W Brownrigg, G Andros, J Apelqvist, E J Boyko, R Fitridge, J L Mills, J Reekers, C P Shearman, R E Zierler, N C Schaper
Symptoms or signs of peripheral artery disease (PAD) can be observed in up to 50% of the patients with a diabetic foot ulcer and is a risk factor for poor healing and amputation. In 2012, a multidisciplinary working group of the International Working Group on the Diabetic Foot published a systematic review on the effectiveness of revascularization of the ulcerated foot in patients with diabetes and PAD. This publication is an update of this review and now includes the results of a systematic search for therapies to revascularize the ulcerated foot in patients with diabetes and PAD from 1980 to June 2014...
January 2016: Diabetes/metabolism Research and Reviews
V Ruppert
No abstract text is available yet for this article.
August 2015: European Journal of Vascular and Endovascular Surgery
M Kallio, P Vikatmaa, I Kantonen, M Lepäntalo, M Venermo, E Tukiainen
OBJECTIVE/BACKGROUND: To analyse the impact of ischaemia and revascularisation strategies on the long-term outcome of patients undergoing free flap transfer (FFT) for large diabetic foot lesions penetrating to the tendon, bone, or joint. METHODS: Foot lesions of 63 patients with diabetes (median age 56 years; 70% male) were covered with a FTT in 1991-2003. Three groups were formed and followed until 2009: patients with a native in line artery to the ulcer area (n = 19; group A), patients with correctable ischaemia requiring vascular bypass (n = 32; group B), and patients with uncorrectable ischaemia lacking a recipient vessel in the ulcer area (n = 12; group C)...
August 2015: European Journal of Vascular and Endovascular Surgery
Milan Flekač
Foot wounds are common problem in people with diabetes and now constitute the most frequent diabetes-related cause of hospitalization. Diabetic foot infections cause substantial morbidity and at least one in five results in a lower extremity amputation. They are are now the predominant proximate trigger for lower extremity amputations worldwide. One in five diabetic wounds present clinical signs of infection at primomanifestation. About 80 % of limb non-threating wounds can be succesfully healed using appropriate and comprehensive approach, including antimicrobial therapy, revascularisation and off-loading...
April 2015: Vnitr̆ní Lékar̆ství
G Torsello, S Debus, F Meyer, R T Grundmann
BACKGROUND: This overview comments on clinical trials and meta-analyses from the literature on the treatment of diabetic feet. METHODS: For the literature review, the MEDLINE database (PUBMED) was searched under the key words "diabetic foot". Publications of the last three years (2012 to 2014) were extracted. RESULTS: For patients with diabetic feet, both endovascular (ER) and open (OR) revascularisation techniques are possible. There are not sufficient data to demonstrate whether open bypass surgery or endovascular interventions are more effective in these patients...
April 2015: Zentralblatt Für Chirurgie
M-C Courtois, M Sapoval, C Del Giudice, R Ducloux, T Mirault, E Messas
Diabetes mellitus is an independent risk factor for peripheral artery disease. Life expectancy is 41 months for diabetic patients with an ischemic ulcer. The characteristics of diabetic arteriopathy make its treatment more difficult than in non-diabetic patients. Few data are available about the surgical treatment of arteriopathy in diabetic patients (including angioplasty or bypass), especially in case of distal arteriopathy. The choice of the procedure depends on multiple factors such as the disease localization, its extent, distal blood flow and vascular disease-related surgical risk...
February 2015: Journal des Maladies Vasculaires
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