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Published on: September 22, 2020
[Algorithm for balloon angioplasty in patients with critical limb ischemia with diabetic foot syndrome]
Yurii A B C D E F B C E F B C D E F Futuyma1, Ihor Kulbaba1, Myroslav Kritsak2
1I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine: Department of Surgery No.1, Urology, Minimally Invasive Surgery and Neurosurgery.
Insights
Diabetic foot syndrome patients with critical limb ischemia benefit from balloon angioplasty, improving tissue viability and microcirculation. This study highlights its priority in surgical treatment for shin-foot segment lesions.
Area of Science:
- Vascular Surgery
- Diabetology
- Wound Healing
Context:
- Diabetic foot syndrome presents challenges in assessing critical limb ischemia (CLI) and selecting patients for revascularization.
- Current criteria for tissue viability are insufficient, complicating treatment decisions.
Purpose:
- To investigate lower extremity microcirculation changes before and after balloon angioplasty in diabetic foot syndrome patients.
- To develop an algorithm for implementing revascularization based on purulent-necrotic complication characteristics.
Summary:
- The study analyzed 67 patients with neuroischemic diabetic foot syndrome, divided into groups based on gangrene type and complications.
- Transcutaneous oxygen pressure (TcpO2) levels significantly increased post-balloon angioplasty in revascularized groups compared to the conservative treatment group.
- TcpO2 improved from pre-revascularization levels (10.35-15.0 mm Hg) to post-revascularization levels (25.06-35.53 mm Hg), indicating enhanced tissue perfusion.
Impact:
- Balloon angioplasty is a priority surgical method for limb ischemia involving shin-foot segment lesions.
- Reperfusion syndrome severity correlates with the number of revascularized vessels.
- Findings may aid in developing better algorithms for managing CLI in diabetic patients.
Abstract:
Currently, there is no reliable and ideal criterion for assessing the level of tissue viability in critical limb ischemia in patients with diabetic foot syndrome, which does not allow the selection of patients for revascularization.
Aim:
The aim is to investigate the microcirculation of the lower extremities before and after balloon angioplasty and to develop an algorithm for its implementation depending on the characteristics of purulent-necrotic complications.
Materials And Methods:
The study was performed in 67 patients with neuroischemic form of diabetic foot syndrome. 3 groups of research were created: the first group included 18 patients with dry gangrene of one toe, several toes or distal foot; in group II - 35 patients with wet gangrene with signs of purulent arthropathy of the toes, phlegmon of the foot and with chronic wounds on the feet and legs; Group 3 - 14 patients diagnosed with purulent-necrotic complications, which were observed in both the 1st and 2nd groups, where patients refused to perform balloon angioplasty. Such patients underwent conservative treatment of lower extremity ischemia.
Results:
It was shown that all patients have low levels of TcpO2- less than 30 mm Hg. The change in the value of TcpO2 during treatment turned out to be interesting: Group I indicator before revascularization was - 15.0±1.31 mm Hg, after the restoration of blood flow for 5- 7 days - 35.53±2.92 mm Hg. after 6 months - 36.67±2.35 mm Hg; Group II before revascularization - 10.35±0.74 mm Hg, for 5-7 days - 25.06±1.13 mm Hg, after 6 months - 34.43±1.97 III group at admission to the hospital - 12.14±0.86 mm Hg, for 5-7 days - 17.14±0.9 mm Hg, after 6 months - 13.71±2.2 mm Hg.
Conclusions:
After revascularization, there is a reperfusion syndrome, the severity of which depends on the number of revascularized vessels of the lower extremity. Balloon angioplasty is one of the priority methods of surgical treatment of limb ischemia with lesions of the shin-foot segment.
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