Medical risk factors in diabetic patients with foot ulcers and severe peripheral vascular disease and their influence on outcome

Background: Diabetic foot problems are the commonest reason for hospitalization of diabetic patients (about 30% of admissions) and absorb some 20% of the total health-care costs of the disease more than all other diabetic complication. The numbers of patients with chronic wounds and wound complications continues to increase. Wound management is a challenge in diabetic wound. Chronic wounds require significant medical, nursing and financial input with poor long-term results. One-third of all diabetic patients have significant peripheral neuropathy and/or peripheral vascular disease (PVD). In India prevalence of foot ulcers in diabetic patients in clinic population is 3%. Over the past several years negative pressure wound therapy (NPWT) using vacuum- assisted closure has emerged as the treatment of complex wounds of the diabetic foot. Many reports on the use of Vacuum Assisted Closure (VAC) therapy after failed revascularization have found increased chances of success. Clinicians should consider negative pressure wound therapy as an adjunct to other modalities in an effort to avoid complications.Methods: Total of 51 patients were included in this prospective study. They were randomly divided into two groups, negative pressure wound therapy (NPWT) group (25 patients) and control group (26 patients) who were treated with regular dressings. All the patients included had peripheral vascular disease which was declared non-revascularisable after vascular workup. Initial mean surface area was measured in each patient. Transcutaneous oxygen pressure was recorded in all the patients and each patient followed up based on their granulation tissue development and need for amputation in each group.Results: After wound management, mean surface area of the diabetic wounds was 39.08cm2 in the NPWT group (P=0.019), and 38.63cm2 in the control group (P=0.327). The use of NPWT may be an effective initial wound therapy to achieve faster wound bed granulation showing signs of healing in 19 among 25 patients (76%) compared to control group 7 showed granulation among 26 patients (26%) (P=0.001). The incidence of secondary higher amputation in NPWT group is 6/25 (24%), the control group 17/26 (65%) (P=0.003), suggesting reduced incidence of secondary higher amputations in NPWT group. After treatment, the experimental group significantly improved in measures of foot ulcer surface area compared with the control group. Further studies are needed to clarify the effects and indications and to modify the technique of this alternative treatment for use on non healing wounds.Conclusions: NPWT-treated patients reached a successful wound treatment endpoint more rapidly, and the benefit was apparent in all wound sizes. NPWT appears to be a safer and efficacious method, than moist wound therapy for the treatment of diabetic foot ulcers.

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Tests for Platelet Changes, Acute Phase Reactants and Serum Lipids in Diabetes mellitus and Peripheral Vascular Disease

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657283 ◽

1982 ◽

Vol 48 (03) ◽

pp. 289-293 ◽

Cited By ~ 17

Author(s):

B A van Oost ◽

B F E Veldhuyzen ◽

H C van Houwelingen ◽

A P M Timmermans ◽

J J Sixma

Keyword(s):

Diabetes Mellitus ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Acute Phase ◽

Serum Lipids ◽

Diabetic Patients ◽

Peripheral Vascular ◽

Acute Phase Reactants ◽

Control Subjects ◽

And Control

SummaryPlatelets tests, acute phase reactants and serum lipids were measured in patients with diabetes mellitus and patients with peripheral vascular disease. Patients frequently had abnormal platelet tests and significantly increased acute phase reactants and serum lipids, compared to young healthy control subjects. These differences were compared with multidiscriminant analysis. Patients could be separated in part from the control subjects with variables derived from the measurement of acute phase proteins and serum lipids. Platelet test results improved the separation between diabetics and control subjects, but not between patients with peripheral vascular disease and control subjects. Diabetic patients with severe retinopathy frequently had evidence of platelet activation. They also had increased acute phase reactants and serum lipids compared to diabetics with absent or nonproliferative retinopathy. In patients with peripheral vascular disease, only the fibrinogen concentration was related to the degree of vessel damage by arteriography.

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The role of LDL-apheresis in the treatment of ulcers due to peripheral vascular disease in diabetic patients: a case report

Transfusion and Apheresis Science ◽

10.1016/s1473-0502(14)50037-7 ◽

2014 ◽

Vol 50 ◽

pp. S16-S17

Author(s):

O. Iuliani ◽

C. Passeri ◽

M. Profico ◽

P. Accorsi

Keyword(s):

Case Report ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Diabetic Patients ◽

Peripheral Vascular ◽

Ldl Apheresis

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A Clinical Study of Bradilan (Tetranicotinoylfructose) in Diabetic Patients with Peripheral Vascular Disease

Journal of International Medical Research ◽

10.1177/030006057500300102 ◽

1975 ◽

Vol 3 (1) ◽

pp. 10-11 ◽

Cited By ~ 2

Author(s):

Cyril Boroda

Keyword(s):

Adverse Effect ◽

Clinical Study ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Diabetic Control ◽

Diabetic Patients ◽

Peripheral Vascular

Nineteen diabetic patients with peripheral vascular disease treated with Bradilan (tetranicotinoylfructose) tablets showed cure or improvement in 14 cases with no adverse effect on their diabetic control. It must therefore be considered a useful drug in the treatment of such diabetic patients with peripheral vascular problems.

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Comparative Histopathology of Radial Artery Versus Internal Thoracic Artery and Risk Factors for Development of Intimal Hyperplasia and Atherosclerosis

Circulation ◽

10.1161/circ.100.suppl_2.ii-139 ◽

1999 ◽

Vol 100 (suppl_2) ◽

Author(s):

Permyos Ruengsakulrach ◽

Roger Sinclair ◽

Masashi Komeda ◽

Jai Raman ◽

Ian Gordon ◽

...

Keyword(s):

Risk Factors ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Radial Artery ◽

Morphometric Analysis ◽

Intimal Hyperplasia ◽

Internal Thoracic Artery ◽

Peripheral Vascular ◽

Luminal Narrowing ◽

Intimal Thickness

Background —In this study, we examined the comparative histopathology, morphometry, and risk factors for the development of intimal hyperplasia and atherosclerosis in the radial artery (RA) and the internal thoracic artery (ITA). Methods and Results —Paired specimens of RAs and ITAs, obtained from 150 patients who underwent CABG, were evaluated with histopathology; 110 pairs of arteries were suitable for morphometric analysis. The severity of disease was evaluated on the basis of percentage of luminal narrowing, intimal thickness index, and intima-to-media ratio. Risk factors were determined with stepwise linear regression. Intimal hyperplasia was seen in 141 RAs (94%) and 103 ITAs (69%) ( P <0.001). Atherosclerosis was seen in 5% of RAs and 0.7% of ITAs ( P =0.04). Medial calcification was found only in RAs (20 of 150, 13.3%) ( P <0.001). Morphometric analysis showed that compared with ITAs, RAs had a significantly higher intimal area, medial area, percentage of luminal narrowing, intimal thickness index, and intima-to-media ratio (all P <0.001) Factors found to be significant ( P <0.05) predictors of the 3 severity indices of intimal hyperplasia, including atherosclerosis, in RAs were peripheral vascular disease, smoking, age, and diabetes. Risk factors for intimal hyperplasia in ITAs were age and smoking. Conclusions —The RA is more likely to have atherosclerosis, intimal hyperplasia, and medial calcification than the ITA. Morphometric analysis indices showed marked differences between the RA and the ITA. Care should be taken when selecting the RA as a conduit in CABG, particularly in patients who are elderly, diabetic, smoke, or have peripheral vascular disease.

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Chiropody May Prevent Amputations in Diabetic Patients on Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686080302300307 ◽

2003 ◽

Vol 23 (3) ◽

pp. 255-259 ◽

Cited By ~ 24

Author(s):

Jennifer Lipscombe ◽

Sarbjit V. Jassal ◽

Susan Bailey ◽

Joanne M. Bargman ◽

Stephen Vas ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Tertiary Care ◽

Diabetic Patients ◽

Care Hospital ◽

Peripheral Vascular ◽

Foot Care ◽

Care Assessment ◽

Patients With Diabetes

← Background A multidisciplinary approach has been shown to be of benefit in the prevention of lower limb ulceration and amputation in patients with diabetes, but there is less information on the role of such an approach in patients receiving dialysis treatment. ← Objective The purpose of the present study was to determine whether the institution of a chiropody program would result in fewer amputations in diabetic patients on peritoneal dialysis (PD). ← Design Retrospective chart review. ← Setting The PD program at a tertiary-care hospital. ← Patients Patients with diabetes that were enrolled in the PD program between January 1997 and December 1999, inclusive, that were offered the opportunity to see a chiropodist, and that agreed to be seen. A total of 132 patients were included. ← Intervention Education about foot care, assessment, and, in some instances, treatment by a chiropodist. ← Results Patients with an amputation were more likely to be male ( p < 0.01) and have peripheral vascular disease ( p < 0.001) compared to those without an amputation. They also had a lower average mean arterial pressure ( p < 0.05), lower weekly creatinine clearance ( p < 0.01), higher mean erythropoietin dose ( p < 0.05), and longer duration of end-stage renal disease ( p < 0.001). Factors that were predictive of shorter time to death or amputation were older age [hazard ratio (HR) = 1.03, p < 0.05], peripheral vascular disease (HR = 2.66, p < 0.01), and cerebrovascular disease (HR = 2.70, p < 0.01). Being seen by a chiropodist was protective (HR = 0.39, p < 0.01). ← Conclusion The current study suggests that a chiropody program may help to prevent amputation in patients with diabetes on PD.

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