Pro- and Anti-Angiogenic Factors: Their Relevance in Diabetic Foot Syndrome—A Review

Angiology ◽  
2021 ◽  
pp. 000331972110426
Author(s):  
Martyna Schönborn ◽  
Patrycja Łączak ◽  
Paweł Pasieka ◽  
Sebastian Borys ◽  
Anna Płotek ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Healing Process ◽  
Arterial Disease ◽  
Angiogenic Factors ◽  
Diabetic Foot Syndrome ◽  
Tissue Loss ◽  
Comprehensive Treatment ◽  
Diabetic Patients ◽  
Impaired Wound Healing ◽  
Peripheral Arterial

Peripheral arterial disease can involve tissue loss in up to 50% of patients with diabetic foot syndrome (DFS). Consequently, revascularization of narrowed or occluded arteries is one of the most common forms of comprehensive treatment. However, technically successful angioplasty does not always result in the healing of ulcers. The pathomechanism of this phenomenon is still not fully understood, but inadequate angiogenesis in tissue repair may play an essential role. Changes in pro- and anti-angiogenic factors among patients with DFS are not always clear and conclusive. In particular, some studies underline the role of decreased concentration of pro-angiogenic factors and higher levels of anti-angiogenic mediators. Nevertheless, there are still controversial issues, including the paradox of impaired wound healing despite high concentrations of some pro-angiogenic factors, dynamics of their expression during the healing process, and their mutual relationships. Exploring this process among diabetic patients may provide new insight into well-known methods of treatment and show their real benefits and chances for improving outcomes.

Diabetic Foot and Footwear

2015 ◽  
Vol 19 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Luximon Ameersing ◽  
Ganesan Balasankar ◽  
Younus Abida
Keyword(s):  
Diabetic Foot ◽  
Plantar Pressure ◽  
Arterial Disease ◽  
Sensory Loss ◽  
Foot Deformities ◽  
Diabetic Patients ◽  
Body Parts ◽  
Foot Ulceration ◽  
Materials Used ◽  
Peripheral Arterial

Diabetes mellitus is one of the most common diseases around the world, and mainly affects the foot among the human body parts. The main causes of the diabetic foot are neuropathy, peripheral arterial disease and foot deformities; it leads to foot ulceration. Generally, sensory loss, high plantar pressure, foot deformities, inappropriate footwear, blindness, and age are the causing risk factors for developing foot ulceration in diabetic patients. Foot ulceration will result in prolonged hospitalization, high medical expenses, and serious complications with lower extremity amputation. For a long time, appropriate footwear has been recommended by physicians for reducing plantar pressure to prevent foot ulceration, the risk of amputation, and re-ulceration. A review is provided in this article towards the existing literature on the causes and prevalence of the diabetic foot, foot ulceration, off-loading pressure, footwear modification for different types of diabetic foot deformities, and types of footwear and textile materials used in footwear insoles for healing purposes.

New possibilities of maximal revascularization of the foot as a limb salvage procedure in diabetics

VASA ◽  
2010 ◽  
Vol 39 (3) ◽  
pp. 278-283 ◽  
Author(s):  
Sauvant ◽  
Hüttenmoser ◽  
Soyka ◽  
Rüttimann
Keyword(s):  
Diabetic Foot ◽  
Arterial Disease ◽  
Major Amputation ◽  
Transluminal Angioplasty ◽  
Lower Limbs ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Salvage Procedure ◽  
Critical Ischemia ◽  
Peripheral Arterial

Diabetics and patients with chronic renal insufficiency often have severe peripheral arterial disease of the distal lower limbs with obstructions of crural and pedal arteries and the imminent risk of critical ischemia and major amputation. Neuroischemic foot ulcers have been shown to fail to heal even after successful arterial revascularization. We report on two diabetic patients with the neuroischemic diabetic foot syndrome and different clinical outcomes after percutaneous transluminal angioplasty of chronic occluded crural arteries and discuss, whether endovascular revascularisation of infrapopliteal and pedal arteries, if possible with complete plantar arch, could promote ulcer healing in neuroischemic diabetic foot ulcers.

The role of the cord blood platelet gel in the management of a diabetic foot with tendon exposure

2021 ◽  
Author(s):  
Mafalda Massara ◽  
Giulia Pucci ◽  
Giuseppe Stilo ◽  
Antonino Alberti ◽  
Rosangela Surace ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Cord Blood ◽  
Diabetic Foot ◽  
Healing Process ◽  
Limb Ischemia ◽  
Blood Platelet ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Platelet Gel ◽  
Vital Functions

Diabetic foot infection is frequent in diabetic patients and is due to neuropathy, trauma or peripheral arterial disease. The presence of an abscess requires urgent drainage and specific antibiotic therapy. Patients with critical limb ischemia need revascularization and, subsequently the intervention of a plastic surgeon is often required in cases of exposure of tendons and ligaments. During the COVID-19 pandemic, a patient was refered to our department with an abscess on the dorsum of the left foot. After urgent drainage with tendon exposure, he started specific antibiotic therapy and underwent tibial vessels angioplasty. After infection healing cord blood platelet gel was applied, accelerating the healing process, with injection of its liquid part into the exposed tendons, thus retaining the vital functions of the tendons.

Nonpharmacological Management of Diabetic Foot Ulcers: An Update

2020 ◽  
pp. 153473462096356 ◽  
Author(s):  
Ioanna Eleftheriadou ◽  
Georgia Samakidou ◽  
Anastasios Tentolouris ◽  
Nikolaos Papanas ◽  
Nikolaos Tentolouris
Keyword(s):  
Diabetic Foot ◽  
Standard Of Care ◽  
Arterial Disease ◽  
Treatment Modalities ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Skin Substitutes ◽  
Cultured Fibroblasts ◽  
Impaired Wound Healing ◽  
Peripheral Arterial

Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes mellitus that is associated with increased morbidity and mortality, as well as substantial economic burden for the health care system. The standard of care for DFUs includes pressure off-loading, sharp debridement, and wound moisture balance, along with infection control and management of peripheral arterial disease. A variety of advanced modalities that target distinct pathophysiological aspects of impaired wound healing in diabetes are being studied as possible adjunct therapies for difficult to heal ulcers. These modalities include growth factors, stem cells, cultured fibroblasts and keratinocytes, bioengineered skin substitutes, acellular bioproducts, human amniotic membranes, oxygen therapy, negative pressure wound therapy, and energy therapies. Additionally, the use of advanced biomaterials and gene delivery systems is being investigated as a method of effective delivery of substances to the wound bed. In the present narrative review, we outline the latest advances in the nonpharmacological management of DFUs and summarize the efficacy of various standard and advanced treatment modalities.

scholarly journals Predictors of intra-hospital mortality in patients with diabetic foot ulcers in Nigeria: data from the MEDFUN Study.

2020 ◽  
Author(s):  
Olufunmilayo O Adeleye ◽  
Ejiofor T Ugwu ◽  
Ibrahim D Gezawa ◽  
Innocent Okpe ◽  
Ignatius Ezeani ◽  
...  
Keyword(s):  
Renal Impairment ◽  
Diabetic Foot ◽  
Arterial Disease ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Low Hdl ◽  
Vascular Stenosis ◽  
Grade 3 ◽  
Peripheral Arterial

Abstract Background/Objective: Diabetic foot ulcers (DFU) are associated with high morbidity and mortality globally. Mortality in patients hospitalized for DFU in Nigeria is unacceptably high. This study is to document contributory factors that predict mortality in patients hospitalized for DFU in Nigeria. Methods: Multi-centre Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN), an observational study conducted in six tertiary healthcare institutions across the 6 geopolitical zones of Nigeria. Consecutive type 1 or 2 diabetic patients hospitalized for DFU who consented. Co-morbid complications were documented. Results: Mean age 55.9 +/- 12.5 years. 96.1% had type 2 diabetes (DM), the mean duration of DM was 8.5 ± 5.7 years. The duration of ulcers was 39 days with a range of 28 to 54 days. 79.2% presented with at least grade 3 DFU. About one-fifth of the patients died (20.5%). Highest mortality among subjects with Wagner grade 5. Middle-aged subjects (45-64 years) had significantly high mortality- odds ratio (OR) 5.107, Confidence interval (CI) of 1.429-18.252.Variables significantly associated with mortality with the respective p- values are DM duration more than 120 months (0.008), ulcer duration > one month (0.013), ulcer severity of Wagner grade 3 and above (0.001), peripheral arterial disease (0.002), foot gangrene (< 0.001). Laboratory variables associated with mortality; proteinuria (<0.001), positive blood cultures (<0.001), severe vascular stenosis (0.001), moderate vascular stenosis (< 0.001), Low HDL (< 0.001). Co-morbid complications significantly associated with mortality; shock at presentation (<0.001), anaemia (0.034), cardiac failure (0.020), renal impairment (<0.001). Sepsis was the strongest predictor of mortality (OR 5.128; 95% CI 2.614 – 10.060) followed by renal impairment (OR 2.831; 95% CI 1.346 – 5.953). Conclusions: Mortality among Nigerian diabetic patients admitted for DFU is high. The majority who died during hospitalization for DFU belong to the working-age population. Predictors of mortality were older age, higher Wagner grade (≥ 3) ulcer, longer duration of DM, longer duration of ulcer, peripheral arterial disease, foot gangrene, renal impairment, low HDL- cholesterol, anaemia, shock, and cardiac failure. Renal impairment and positive blood culture were independent determinants of mortality.

P1044RENAL DIABETIC FOOT: DIFFERENT PATTERNS AND CHARACTERIZATION OF PERIPHERAL ARTERY DISEASE BETWEEN NON-UREMIC AND UREMIC DIABETIC PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Michele Ferrannini ◽  
Giulia Marrone ◽  
Georgia Wilson Jones ◽  
Marco Meloni ◽  
Annalisa Romani ◽  
...  
Keyword(s):  
Renal Disease ◽  
Diabetic Foot ◽  
Independent Predictor ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Anterior Tibial Artery ◽  
Arterial Lesions ◽  
Complex Diabetes ◽  
Peripheral Arterial ◽  
Stage Renal Disease

Abstract Background and Aims The diabetic foot (DF) was traditionally considered a local foot problem due to diabetes; however many observations support the concept that the DF is actually a part of a more complex diabetes related syndrome which includes several long-term complications and co-morbidities. In recent years, an increase in the incidence of ischemic diabetic foot ulcers (DFUs) amongst dialyzed subjects has been observed, going up from approximately 5-10% fifteen years ago to the current rate of approximately 30-35%. Today it is well recognized that end stage renal disease (ESRD) is an independent risk factor for non-healing ulcers and amputation in diabetic subjects. In clinical practice, the presence of foot problems in ESRD diabetic patients is identified as a specific entity termed “renal-diabetic foot”. The aim of this study is to describe the angiographic characteristics of peripheral arterial disease (PAD) in patients with DFUs receiving chronic dialysis treatment. Method The study group was composed of patients with DFUs and PAD who referred to our diabetic foot unit. All patients have been managed with a pre-set limb salvage protocol including revascularization of the affected limb. Arterial lesions (stenosis between 50-99% and occlusions) were retrospectively evaluated through angiogram analysis. According to the presence of dialytic treatment, patients were divided in two subgroups: renal-diabetic foot (RDF) and diabetic foot (DF). Patterns of PAD and immediate revascularization outcome (technical revascularization outcome) for RDF and DF were separately reported and compared Results The demographic and clinical characteristics were reported in Table 1.RDF reported greater number of affected vessels (n= 5±1.6 vs 3.9±1.5, p&lt;0.0001), greater involvement of the superficial femoral artery (90.2 vs 75.8%, p=0.003), tibial-peroneal trunk (53.7 vs 25.5%, p=0.01), anterior tibial artery (93.9 vs 80.9%, p=0.03) and below-the-ankle arteries (70.7 vs 35.7%, p=0.0001) than DF patients. RDF showed a higher rate of revascularization failure (43.9 vs 15.3%, p&lt;0.0001) in comparison to DF patients (Table 2). Below-the-ankle (BTA) arterial disease [OR 9.5 (CI 95% 3.5-25.4) p=0.0001] resulted as the only independent predictor of revascularization failure. Conclusion It was interesting to highlight that the above mentioned findings could be specifically related to the effect of renal disease on the arteries of the lower extremity because the two groups, RDF and DF, did not report any difference in terms of other traditional cardiovascular risk factors (age, smoke, arterial hypertension, dyslipidemia, diabetes duration) which could influence the characteristics of PAD. RDF patients showed a widespread distribution of arterial lesions with a higher involvement of foot arteries in comparison to DF subjects. BTA arterial disease is an independent predictor of revascularization failure.

scholarly journals Treatment of Diabetic Wounds With Photodynamic Therapy - Preliminary Results

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A422-A422
Author(s):  
Mariana Berbert ◽  
Sicilia Arruda ◽  
Camila Bichuetti ◽  
Alice Campos ◽  
Patricia Ceron ◽  
...  
Keyword(s):  
Photodynamic Therapy ◽  
Healing Process ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Promising Alternative ◽  
Significance Level ◽  
Injury Reduction ◽  
End Of Treatment ◽  
Peripheral Arterial ◽  
Diabetic Wounds

Abstract Diabetic patients have greater susceptibility to developing diabetic foot ulcers (DFU), which associated with peripheral arterial disease and/or infection, causes greater difficulty in the healing process. Photodynamic therapy (PDT) presents itself as a promising alternative for ulcer healing. This study aims to analyze the effectiveness and benefits of PDT in the treatment of diabetic wounds, associating the presence of arteriopathy, the size of the lesion, the presence and type of infection and the need for amputation. After the approval of the ethics committee in research and signing of the TCLE, six patients with eight diabetic wounds were evaluated. The study was carried out in an outpatient clinic of a medium complexity hospital in the interior of Minas Gerais, Brazil, with frequency of two weekly meetings, for a period of 5 months. Cultures were collected at the beginning and end of treatment, arterial doppler of the affected lower limb was performed. The photosensitizer used was methylene blue, with subsequent emission of LED light at a power of 100 mW/cm2, for 10 minutes. The data were analyzed by the Qui2 test, using the Software SPSS 25.0, with a significance level of 5% and are described with mean ± EPM. Age was 65.50 ± 7.58 years, 50% male. All had type 2 diabetes mellitus and the disease time was 9.50 ± 8.22 years. Five reported the presence of comorbidities such as SAH and dyslipidemia, and two presented concomitantly nephropathy and retinopathy. One patient was a smoker and two reported previous smoking. All lesions presented grade I classification by Texas classification (superficial cleft not involving tendon, capsule or bone). Five stage B ulcers (infection only), two stage C ulcers (ischemia only) and A stage D ulcer (infection and ischemia). At US arterial doppler, three patients had total viability of the affected limb and three presented arteriopathy, but only two with collateral. There was no association between arteriopathy and injury reduction (p=0.109). The mean area of injury was 11.15 ± 14.93 cm2. There was a reduction of 46.51 ± 31.10%. There was no association between injury area and percentage of reduction (p = 0.213), but there is a tendency for greater reductions in smaller lesions. Infection was present in 75% of the lesions. There was no association between the presence of infection and reduction of lesions (p=0.446). So far, we can conclude that the presence of arteriopathy without collateral, makes the procedure impossible. There was no association with the presence of infection and reduction of the lesion, and can also be used as a stimulator of the healing process. There was no association with wound size and percentage of reduction. It’s a promising therapy that should be better analyzed.

scholarly journals Clinical study, management of diabetic foot and its complications

2021 ◽  
Author(s):  
Manivannan Dhanraj ◽  
Paulia Devi Thanislas ◽  
Maniselvi Samidurai ◽  
Kannan Ross
Keyword(s):  
Diabetic Foot ◽  
Arterial Disease ◽  
Treatment Modalities ◽  
Diabetic Patients ◽  
Team Approach ◽  
Optimal Method ◽  
Diabetic Foot Infections ◽  
Patients At Risk ◽  
Foot Lesions ◽  
Peripheral Arterial

Background: Diabetic foot infections are frequently polymicrobial. Hyperglycemia, impaired immunologic responses, neuropathy and peripheral arterial disease are the major predisposing factors leading to limb-threatening diabetic foot infections. The aim of the study was to study the benefit and outcome of the different treatment modalities for the diabetic foot.Methods: This study was conducted comprising 100 patients with diabetic foot in the department of general surgery at Rajiv Gandhi government general hospital, MMC from January 2019 to June 2020, over 12 months. Data were collected by detailed history, clinical examination, wound or ulcer and were recorded in the pre-designed proforma. Wagner’s classification, examination findings, blood investigations, renal function test, a swab of the wound, X-ray and treatment provided were collected.Results: Commonest presenting lesion was ulcers (44%), followed by gangrene (24%) and cellulitis (20%). The commonest site of the lesion was the dorsum of the foot (32%), followed by forefoot (28%) and toes (22%). Trivial trauma is the initiating factor in more than half of the cases. More than half of the patients, 82% had an infection. The most common microorganism grown from culture was Staphylococcus aureus (30%).Conclusions: Diabetic patients at risk for foot lesions must be educated about risk factors. The multidisciplinary team approach diabetic foot disorders has been demonstrated as the optimal method to achieve favorable rates of limb salvage in a high-risk diabetic patient. Infection in a diabetic foot is potentially limb-threatening and always requires urgent diagnostic and therapeutic attention. 

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