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Diabetic foot revascularisation

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, χ(2) = 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
R O Forsythe, J Brownrigg, R J Hinchliffe
Diabetes is a complex disease with many serious potential sequelae, including large vessel arterial disease and microvascular dysfunction. Peripheral arterial disease is a common large vessel complication of diabetes, implicated in the development of tissue loss in up to half of patients with diabetic foot ulceration. In addition to peripheral arterial disease, functional changes in the microcirculation also contribute to the development of a diabetic foot ulcer, along with other factors such as infection, oedema and abnormal biomechanical loading...
May 2015: Diabetes, Obesity & Metabolism
A Aiello, R Anichini, E Brocco, C Caravaggi, A Chiavetta, R Cioni, R Da Ros, M E De Feo, R Ferraresi, F Florio, M Gargiulo, G Galzerano, R Gandini, L Giurato, L Graziani, L Mancini, M Manzi, P Modugno, C Setacci, L Uccioli
Diabetic foot (DF) is a chronic and highly disabling complication of diabetes. The prevalence of peripheral arterial disease (PAD) is high in diabetic patients and, associated or not with peripheral neuropathy (PN), can be found in 50% of cases of DF. It is worth pointing out that the number of major amputations in diabetic patients is still very high. Many PAD diabetic patients are not revascularised due to lack of technical expertise or, even worse, negative beliefs because of poor experience. This despite the progress obtained in the techniques of distal revascularisation that nowadays allow to reopen distal arteries of the leg and foot...
April 2014: Nutrition, Metabolism, and Cardiovascular Diseases: NMCD
O A Shumkov, M S Liubarskiĭ, I A Altukhov, M Iu Soluianov, M A Smagin
The efficacy of the percutaneous transluminal balloon angioplasty in patients with critical ischemia of the lower limbs and diabetes mellitus was analyzed. The study included 102 patients with septic complications of the diabetic foot syndrome. The main group consisted of 37 patients, who received both the traditional conservative therapy and the endovascular angioplasty. The study proves that the endovascular interventions by diabetic foot syndrome are effective and justified. Revascularisation permits the minimal resectional interventions on the foot, stop the ischemia and minimize the number of repeated necrectomies and high amputations...
2013: Khirurgiia
J B Ricco, L Thanh Phong, F Schneider, G Illuminati, R Belmonte, A Valagier, G Régnault De La Mothe
Diabetic foot ulceration (DFU) is among the most frequent complications of diabetes. Neuropathy and ischaemia are the initiating factors and infection is mostly a consequence. We have shown in this review that any DFU should be considered to have vascular impairment. DFU will generally heal if the toe pressure is >55 mmHg and a transcutaneous oxygen pressure (TcPO2) <30 mmHg has been considered to predict that a diabetic ulcer may not heal. The decision to intervene is complex and made according to the symptoms and clinical findings...
December 2013: Journal of Cardiovascular Surgery
Raffaele Serra, Raffaele Grande, Edoardo Scarcello, Gianluca Buffone, Stefano de Franciscis
Peripheral vascular disease is a common complication of type 2 diabetes and is often more severe and diffuse than in non-diabetic individuals with a higher risk of major amputations in the lower limbs. Diabetic foot revascularisation using both traditional bypass surgery and endovascular therapy are often burdened by the failure and the inevitable subsequent massive amputation. In this study, we examined the clinical response of diabetic patients with critical limb ischaemia and extended ischaemic wounds, treated with a new angiosome-based revascularisation technique...
October 2015: International Wound Journal
Manuel Pardo, Miguel Alcaraz, Fernando Luis Bernal, Jose Manuel Felices, Gyingriri Daniel Achel, Francisco Ramon Breijo-Marquez, Manuel Canteras
PURPOSE: We evaluated the limitations of the ankle-brachial index (ABI) in the revascularisation of diabetic patients with critical limb ischaemia (CLI) who were undergoing peripheral transluminal angioplasty (PTA) compared with the degree of arterial stenosis and with transcutaneous oxygen tension (TcpO2). MATERIALS AND METHODS: This prospective study assessed 250 consecutive diabetic patients in whom we evaluated results of posterior tibial and dorsalis pedis Doppler, ABI, TcpO2, and duplex scans...
December 2013: La Radiologia Medica
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