Outcomes of Minor Amputations in Patients with Peripheral Vascular Disease at a Tertiary Care Institution

Background: Foot infection is a common problem affecting diabetics. Ischemia is a major factor contributing to progress and morbidity of the disease. The prevalence of peripheral vascular disease is higher in diabetics with faster progression. Aim: This study aimed to observe the prevalence of peripheral vascular disease in patients with diabetic foot infections presenting to this tertiary care centre. Methods: This prospective observational study evaluated 250 patients with diabetic foot infection admitted to Ibrahim Medical College and BIRDEM General Hospital, Dhaka, from 1st January 2015 to 31st December 2015.Total 72 patients were selected for Duplex study of lower limb vessels, Ankle Brachial Pressure Index (ABPI) and Pulse oxymetrywhich established the diagnosis of peripheral vascular disease and all patients were treated according to the standard protocol. Results: Of the 72 patients peripheral vascular disease was found in 25 patients (34.7%) and majority of them (88%) had distal below the knee vessel stenosis. There was significant correlation with older age (75%) and history of tobacco use (64%). The clinical presentations and outcomes such as hospital stay, healing time, pain were worse in individuals with peripheral vascular compromise on Duplex study of lower limb vessels, ABPI and pulse oxymetry. Conclusion: In this study we observed that significant number of diabetics presenting with foot infections have underlying peripheral vascular disease .The patients might not all be symptomatic or show obvious signs of PVD but need to be investigated for the same. Early detection of peripheral vascular disease in patients presenting with diabetic foot infection, using Duplex study,ABPI and Pulse oxymetrywith routine clinical and laboratory assessment can be of great value in long term care of these individuals. J Bangladesh Coll Phys Surg 2020; 38(1): 12-17

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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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A clinical study of peripheral vascular disease due to atherosclerosis in diabetic foot infections

International Surgery Journal ◽

10.18203/2349-2902.isj20180806 ◽

2018 ◽

Vol 5 (3) ◽

pp. 931

Author(s):

A. Tyagi ◽

S. Lavanya ◽

G. Hari Prasad ◽

G. Hari Prasad

Keyword(s):

Clinical Study ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Diabetic Foot ◽

Tertiary Care ◽

Diabetic Patients ◽

Peripheral Vascular ◽

Foot Care ◽

Below The Knee ◽

Diabetic Foot Infections

Background: Foot infection is a common problem affecting diabetics. Ischemia is a major factor contributing to progress and morbidity of the disease. The prevalence of peripheral vascular disease is higher in diabetics, with faster progression. The prevalence differs among populations. This study aimed to clinical prevalence of peripheral vascular disease due to atherosclerosis in patients with diabetic foot infections presenting to this tertiary care centre.Methods: This clinical study was conducted in ASRAM hospital, Eluru, Andhra Pradesh, India. All patients admitted with a diagnosis of diabetic foot infection to the department of general surgery during a period between October 2015 to October 2017, who fulfilled the inclusion and exclusion criteria, were enrolled for the study. After recording the pertinent information (as per performa), patients were subjected to a lower limb arterial Doppler and ABPI findings were tabulated.Results: Peripheral vascular disease was found in 35% of patients studied. Majority had distal below the knee vessels stenosis or occlusion. There was significant correlation with age, history of tobacco use and various risk factors. The clinical presentations and outcomes were worse in individuals found to have peripheral vascular compromise on arterial Doppler study.Conclusions: The care of diabetic patients should start with preventive measures which include proper foot care, glycaemic control and education about diabetic foot are key factors for better out come and quality of life.

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An audit of vascular surgery experience at North Surgical Unit, Mayo Hospital Lahore

Annals of King Edward Medical University ◽

10.21649/akemu.v12i1.858 ◽

2016 ◽

Vol 12 (1) ◽

Author(s):

Khalid Irshad ◽

Omar Salahuddin ◽

Intesarur Rashid ◽

Raza S ◽

Abdul Majeed Chaudhry

Keyword(s):

Vascular Disease ◽

Peripheral Vascular Disease ◽

Tertiary Care ◽

Late Presentation ◽

Aortic Aneurysms ◽

Peripheral Vascular ◽

Non Invasive ◽

Run Off ◽

First Choice ◽

Risk Patients

The prevalence of Peripheral vascular disease, Carotid artery stenosis and Aortic aneurysm in our society is higher than generally accepted because of higher incidence of established modifiable risk factors like Smoking, Diabetes, Hypertension and Hyperlipidaemia. We present a review of 246 patients with prospective collection of data who were referred for opinion to North Surgical Ward Mayo Hospital Lahore from March 2005 to February 2006. Surgical treatment was possible in 165 patients. Amongst remaining 81 patients 38 presented late and had amputations either in referring unit or with us and 43 were managed conservatively or under follow up. 24 prosthetic grafts were used, 8 in Aortic aneurysms, 4 in carotid endarterectomies and 11 in iliofemoral reconstructions with no peri-operative mortality or stroke. We had 2 grafts occlusion and amputations in critically ischaemic patients who had single vessel run off. Non invasive investigations were the first choice in Carotid and peripheral vascular disease. Conclusion: Our experience shows higher incidence of late presentation and under treatment of these high risk patients which need patient awareness and life style modification at community level. We advocate multidisciplinary approach and establishment of fully supported dedicated peripheral vascular and endovascular services at tertiary care level.

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Management of upper extremity peripheral vascular disease: a multimodality approach

International Surgery Journal ◽

10.18203/2349-2902.isj20202393 ◽

2020 ◽

Vol 7 (6) ◽

pp. 1842

Author(s):

Prasad Upganlawar ◽

Ashwinee Rahalkar ◽

Sneha Joshi ◽

Simran Khatri

Keyword(s):

Interventional Radiology ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Upper Extremity ◽

Tertiary Care ◽

General Surgeon ◽

Peripheral Vascular ◽

Vascular Surgeon ◽

Early Management ◽

Number Of Patients

Background: It is estimated that more than 200 million people suffer from peripheral vascular disease worldwide. However very few studies are available on upper extremity vascular disease, thus making it an under diagnosed and under treated condition.Methods: In the present study we included 20 participants suffering from upper limb peripheral vascular disease and managed them with multi-modality approach involving general surgeon, interventional radiologist and vascular surgeon for medical line of management, thrombolysis and thrombo-embolectomy procedures.Results: In the present study we observed that early management of these patients with medical management, interventional radiology and embolectomy procedures helped in limb salvage. However alarmingly high number of patients (35%) landed up in amputation because of low index of suspicion and delayed referral.Conclusions: A high level of suspicion and early referral to a tertiary care centre where multi-modality facilities like interventional radiology and vascular surgeon are available should be done.

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Clinical Analysis of Peripheral Vascular Diseade in Patients with Diabetes Mellitus

Journal of Diabetes and Endocrine Association of Nepal ◽

10.3126/jdean.v3i2.27520 ◽

2019 ◽

Vol 3 (2) ◽

pp. 18-24

Author(s):

Dipak Malla ◽

Sukesh Purush Dhakal

Keyword(s):

Diabetes Mellitus ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Tertiary Care ◽

Clinical Syndrome ◽

Peripheral Vascular ◽

Diabetic Mellitus ◽

Tertiary Care Centre ◽

Laboratory Assessment ◽

Term Care

Introduction: Diabetes Mellitus (DM) is clinical syndrome characterized by hyperglycemia due to absolute or relative deficiency of insulin. The metabolic dysregulation associated with DM causes multitude of secondary pathophysiological changes in multiple organ system causing macro vascular (coronary artery disease, peripheral vascular disease, cerebrovascular disease) and micro vascular (retinopathy, neuropathy, and nephropathy) complications. This study aimed to study the prevalence of peripheral vascular disease in patients with diabetic mellitus presenting to this tertiary care centre. Methods: This clinical study was conducted in first affiliated hospital of Yangtze university, Jingzhou. All patients with a diagnosis of diabetic mellitus who came to Out patient department of Endocrinology & diabetic clinic and admitted in the hospital during a period between October 2013 to October 2014, who fulfill, were enrolled for the study. This was a single centered retrospective observational analylitcal study conducted in Department of Endocrinology of First affiliated Hospital of Yangtze, China. Results: Peripheral vascular disease was found in 35% of patients studied . There was significant correlation. Conclusion: A significant number of diabetics presenting with diabetes mellitus have underlying peripheral vascular disease. The patients might not all be symptomatic or show obvious signs of PVD but need to be investigated for the same. The older the individual the more the chances of having peripheral vascular compromise. Also a tobacco user and patient presenting with worse clinical findings is more likely to have PVD. Thus the detection of peripheral vascular disease in patients using Arterial Doppler studies along with routine clinical and laboratory assessment can be of great value in long term care of these individualsith age, and history of tobacco use.

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HYPOCHLOROUS ION BASED DRESSING: THROWBACK TO THE SURGEONS’ CHOICE

10.36106/gjra/6017724 ◽

2021 ◽

pp. 273-276

Author(s):

Manikantha G ◽

Hemant Muktaram Jawale ◽

Akshat Awdhesh Kumar Mishra ◽

Amarjeet E Tandur ◽

Pratik J Agrawal

Keyword(s):

Vascular Disease ◽

Surface Area ◽

Peripheral Vascular Disease ◽

Pressure Ulcer ◽

Normal Saline ◽

Tertiary Care ◽

Care Facility ◽

Control Group ◽

Wound Surface ◽

Peripheral Vascular

1.1 BACKGROUND : As per Robbin's pathology(Robbins & Cotran Pathologic Basis of Disease - 10th Edition, n.d.) "an ulcer is the breach of the continuity of skin, epithelium or mucous membrane caused by sloughing out of inamed necrotic tissue." In an era of modern-day fast track surgery and premier practices of medicine, management of wound remains an archaic, almost omnipresent challenge to a health care provider mediating the need for solutions. The hunt for an optimum dressing agent has been everlasting, one of which is our point of discussion in this study. The addition of Chlorine(Cl2) to Water(H2O) gives rise to Hypochlorous ion, a weak acid that has been used traditionally as disinfectant, sterilizer and beaches. These properties can be utilised for wound disinfection and swifter wound healing. 1.2 AIMS AND OBJECTIVES: Ÿ To study the efcacy of Hypochlorous ion-based dressing over traditional normal saline based dressing . Ÿ To study the effects factoring in various associated comorbidities in patients such as Diabetes Mellitus, Peripheral Vascular Disease, Trauma and Pressure Ulcer. 1.3 METHODOLOGY: A comparative study was conducted in a tertiary care facility in India that included 101 patients who were distributed randomly utilizing computerised algorithms into study and control group. The control group received daily normal saline dressing whereas the study group underwent daily hypochlorous ion-based dressing. The subjects were analysed after 4 weeks and evaluated for decrease in wound surface area and improvement of wound quality and tabulated for analysis. 1.4 CONCLUSION: Hypochlorous ion based daily dressing shows signicant reduction in wound surface area as well as signicantly better and faster improvement in the quality of wound in patients of Traumatic, Diabetic and Pressure Ulcer whereas the results in patients suffering from Peripheral Vascular Disease were equivocal.

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Outcomes of minor amputations in patients with peripheral vascular disease over a 10-year period at a tertiary care institution

Vascular ◽

10.1177/1708538118797544 ◽

2018 ◽

Vol 27 (1) ◽

pp. 8-18 ◽

Cited By ~ 1

Author(s):

Amy S Chan ◽

Janice Montbriand ◽

Naomi Eisenberg ◽

Graham Roche-Nagle

Keyword(s):

Vascular Disease ◽

Peripheral Vascular Disease ◽

Tertiary Care ◽

Major Amputation ◽

Study Endpoint ◽

Peripheral Vascular ◽

Long Term Outcome ◽

Amputation Level ◽

Posterior Tibial ◽

Healing Wounds

Objectives Choosing an optimal amputation level requires balance between maximizing limb salvage while minimizing chances of non-healing wounds and re-amputation. Our aim was to assess the long-term outcome for minor amputations in patients with peripheral vascular disease. Methods A retrospective study of minor amputations between January 1, 2005 and December 31, 2015 was performed. Electronic medical records of eligible patients were examined to extract demographics, co morbidities and clinical data. Results Within the study period, 220 patients underwent 296 primary minor amputations in 244 lower extremities. Wound healing was achieved in 18.2% (54 of 296 amputations) and 43.6% (129 of 296 amputations) at 90 days and 365 days, respectively. Rates of progression to major amputation were 16.4% (40 or 244 limbs) and 21.7% (53 of 244 limbs) at 90 days and 365 days, respectively. In the final multivariate model, lower ipsilateral posterior tibial waveforms predicted poor 90-day healing (OR = 2.22, p = 0.01) as well as limb loss (OR = 3.02, p = 0.02) in a dose-response manner. In the final logistic regression model, emergency department admission (OR = 0.20, p < 0.01), ipsilateral posterior tibial waveform (OR = 2.63, p < 0.01), and post-operative infection (OR = 0.30, p < 0.01) were predictors of poor healing status at study endpoint. Conclusion This study shows that a majority of foot amputees require ongoing care for non-healing wounds and a proportion necessitate conversion to major amputation. Adequate vascularization is essential to promote and maintain healing.

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