scholarly journals Peripheral arterial disease in patients with renal-diabetic foot ulcers

2021 ◽  
Vol 30 (8) ◽  
pp. 660-664
Author(s):  
Marco Meloni ◽  
Valentina Izzo ◽  
Laura Giurato ◽  
Valerio Da Ros ◽  
Daniele Morosetti ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Diabetic Foot ◽  
Independent Predictor ◽  
Arterial Disease ◽  
Foot Ulcers ◽  
Anterior Tibial Artery ◽  
Diabetic Foot Ulcers ◽  
Arterial Lesions ◽  
Patient Groups ◽  
Peripheral Arterial

Objective: To describe the angiographic characteristics of peripheral arterial disease (PAD) in persons with diabetic foot ulcers (DFUs) on dialysis treatment. Method: The study is a retrospective analysis of patients with DFUs and PAD who had been referred to our diabetic foot clinic. All patients had been managed by a pre-set limb salvage protocol including revascularisation of the affected limb. Arterial lesions (stenosis between 50–99% and occlusions) were retrospectively evaluated through angiogram analysis. According to the presence or not of dialysis, patients were divided into two patient groups: renal-diabetic foot (RDF) and diabetic foot (DF). Distribution of PAD and immediate revascularisation outcome (technical revascularisation outcome) for RDF and DF were separately reported and compared. Results: The sample included 239 patients: mean age was 71.8 years; 72.4% were male; 87.4% had type 2 diabetes; mean diabetes duration was 21.4 years; and the mean HbA1c was 63±22mmol/mol. The RDF group compared with the DF group reported higher numbers of vessels affected (n=5±1.6 versus 3.9±1.5, respectively, p<0.0001), greater involvement of the superficial femoral artery (90.2% versus 75.8%, respectively, p=0.003), the tibial-peroneal trunk (53.7% versus 25.5%, respectively, p=0.01), the anterior tibial artery (93.9% versus 80.9%, respectively, p=0.03) and below-the-ankle (BTA) arteries (70.7% versus 35.7%, respectively, p=0.0001). The RDF group showed a higher rate of revascularisation failure in comparison to DF patients (43.9% versus 15.3%, respectively, p<0.0001). BTA arterial disease (odds ratio 9.5; 95% Confidence Interval: 3.5–25.4; p=0.0001) resulted as the only independent predictor of revascularisation failure. Conclusion: In this study, RDF patients showed a widespread distribution of arterial lesions with a higher involvement of foot arteries in comparison with DF patients. BTA arterial disease was found to be an independent predictor of revascularisation failure.

Wound management of chronic diabetic foot ulcers: From the basics to regenerative medicine

2015 ◽  
Vol 39 (1) ◽  
pp. 29-39 ◽  
Author(s):  
Karen L Andrews ◽  
Matthew T Houdek ◽  
Lester J Kiemele
Keyword(s):  
Peripheral Arterial Disease ◽  
Diabetic Foot ◽  
Arterial Disease ◽  
Current Treatment ◽  
Foot Ulcers ◽  
Foot Deformities ◽  
Minor Trauma ◽  
Diabetic Foot Ulcers ◽  
Number Of Patients ◽  
Peripheral Arterial

Background: Hospital-based studies have shown that mortality rates in individuals with diabetic foot ulcers are about twice those observed in individuals with diabetes without foot ulcers. Objective: To assess the etiology and management of chronic diabetic foot ulcers. Study design: Literature review. Methods: Systematic review of the literature discussing management of diabetic foot ulcers. Since there were only a few randomized controlled trials on this topic, articles were selected to attempt to be comprehensive rather than a formal assessment of study quality. Results: Chronic nonhealing foot ulcers occur in approximately 15% of patients with diabetes. Many factors contribute to impaired diabetic wound healing. Risk factors include peripheral neuropathy, peripheral arterial disease, limited joint mobility, foot deformities, abnormal foot pressures, minor trauma, a history of ulceration or amputation, and impaired visual acuity. With the current treatment for nonhealing diabetic foot ulcers, a significant number of patients require amputation. Conclusion: Diabetic foot ulcers are optimally managed by a multidisciplinary integrated team. Offloading and preventative management are important. Dressings play an adjunctive role. There is a critical need to develop novel treatments to improve healing of diabetic foot ulcers. The goal is to have wounds heal and remain healed. Clinical relevance Diabetic neuropathy and peripheral arterial disease are major factors involved in a diabetic foot ulcer. Despite current treatment modalities for nonhealing diabetic foot ulcers, there are a significant number of patients who require amputations. No known therapy will be effective without concomitant management of ischemia, infection, and adequate offloading.

scholarly journals PENATALAKSANAAN ULKUS KAKI DIABETES SECARA TERPADU

2013 ◽  
Vol 3 (2) ◽  
Author(s):  
Yuanita A. Langi
Keyword(s):  
Wound Healing ◽  
Growth Factors ◽  
Peripheral Arterial Disease ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Arterial Disease ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Peripheral Arterial

Abstract: A diabetic foot ulcer is a common and fearful chronic complication of diabetes mellitus often resulting in amputation, and even death. A diabetic foot ulcer can be prevented by early screening and education in high risk individuals, and the management of underlying conditions such as neuropathy, peripheral arterial disease, and deformity. The prevalence of diabetic foot ulcer patients is 4-10% of the general population, with a higher prevalence in elderly people. Around 14-24 % of diabetic foot ulcer patients need amputations with a recurrence rate of 50% after three years. The main pathogenesis of diabetic foot ulcer is neuropathy and peripheral arterial disease (PAD). PAD contributes to diabetic foot ulcers in 50% of cases; however, it rarely stands alone. Other factors such as smoking, hypertension, and hyperlipidemia may contribute, too. In addition, PAD reduces the access of oxygen and antibiotics to the ulcers. Management of diabetic foot ulcers includes treatment of ischemia by promoting tissue perfusion, debridement for removing necrotic tissues, wound treatment for creating moist wound healing, off-loading the affected foot, surgery intervention, management of the co-morbidities and infections, and prevention of wound recurrences. Other adjuvant modalities include hyperbaric oxygen treatment, GCSF, growth factors, and bioengineered tissues. Key words: diabetic ulcer, debridement, off loading.   Abstrak: Ulkus kaki diabetes (UKD) merupakan salah satu komplikasi kronik diabetes melitus yang sering dijumpai dan ditakuti oleh karena pengelolaannya sering mengecewakan dan berakhir dengan amputasi, bahkan kematian. UKD dapat dicegah dengan melakukan skrining dini serta edukasi pada kelompok berisiko tinggi, dan penanganan penyebab dasar seperti neuropati, penyakit artei perifer dan deformitas. Prevalensi pasien UKD berkisar 4-10% dari populasi umumnya, dengan prevalensi yang lebih tinggi pada manula. Sekitar 14-24% pasien UKD memerlukan amputasi dengan rekurensi 50 % setelah tiga tahun. Patogenesis utama UKD yaitu neuropati dan penyakit arteri perifer (PAP). PAP berkontribusi 50% pada pasien UKD, tetapi hal ini jarang dijumpai tunggal. Terdapat faktor-faktor lain yang turut berperan seperti merokok, hipertensi dan hiperlipidemia. Selain itu PAP menurunkan akses oksigen dan antibiotik ke dalam ulkus. Penatalaksanaan UKD meliputi penanganan iskemia dengan meningkatkan perfusi jaringan, debridemen untuk mengeluarkan jaringan nekrotik, perawatan luka untuk menghasilkan moist wound healing, off-loading kaki yang terkena, intervensi bedah, pananganan komorbiditas dan infeksi, serta pencegahan rekurensi luka. Terapi ajuvan meliputi terapi oksigen hiperbarik, pemberian granulocyte colony stimulating factors (GCSF), growth factors dan bioengineerd tissues. Kata kunci: ulkus diabetes, debridemen, off loading.

scholarly journals The Evaluation and Treatment of Diabetic Foot Ulcers and Diabetic Foot Infections

2018 ◽  
Vol 3 (3) ◽  
pp. 247301141878886 ◽  
Author(s):  
Michael A. Del Core ◽  
Junho Ahn ◽  
Robert B. Lewis ◽  
Katherine M. Raspovic ◽  
Trapper A. J. Lalli ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Diabetic Neuropathy ◽  
Diabetic Foot ◽  
Arterial Disease ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Immune System Dysfunction ◽  
Diabetic Foot Disease ◽  
Foot Disease ◽  
Peripheral Arterial

Diabetic foot ulcers and infections are common complications of diabetic foot disease. Additionally, these complications are a common cause of morbidity and impose a substantial burden to the patient and society. It is imperative to understand the major contributing factors, namely, diabetic neuropathy, peripheral arterial disease, and immune system dysfunction in order to guide treatment. Management of diabetic foot disease begins with a detailed history and thorough physical examination. This examination should focus on the manifestations of diabetic neuropathy and peripheral arterial disease, and, in particular, any evidence of diabetic foot ulcers or infection. Prevention strategies should include a multi-disciplinary approach centered on patient education.

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 Platelet Lysate and Non-Healing Ulcers

2021 ◽  
Vol 11 (4) ◽  
pp. 12267-12274
Keyword(s):  
Peripheral Arterial Disease ◽  
Diabetic Foot ◽  
Venous Insufficiency ◽  
Arterial Disease ◽  
Platelet Lysate ◽  
Bioactive Molecules ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Surface ◽  
Peripheral Arterial

Platelet lysate contained a wide range of bioactive molecules involved in cell proliferation, migration. The paper analyzes the possibility of using platelet lysate for the treatment of non-healing ulcers. The levels of bioactive molecules were determined by ELISA in platelet lysate. Efficacy of treatment with platelet lysate patients with diabetic foot ulcers, ulcers in patients with peripheral arterial disease and venous insufficiency were analyzed on wound surface area, total epithelialization. Twice injection of platelet lysate with an interval of 5-7 days possess to wound surface area closure on Day 180 at 96% in patients with diabetic foot ulcers, while in patients with peripheral arterial disease and venous insufficiency ulcers wound closure was less. Platelet lysate from patients with non-healing ulcers contained growth factor, cytokine, components of the extracellular matrix, and nitric oxide. Between levels of bioactive molecules in platelet lysate and outcome were found significant correlation. The obtained results indicate that platelet lysate possesses wound healing activity.

scholarly journals Prospective observational study evaluating association of sociodemographic parameters, Wagner’s grading, peripheral arterial disease and diabetic peripheral neuropathy with the outcomes of diabetic foot ulcers

2020 ◽  
Vol 7 (7) ◽  
pp. 2129
Author(s):  
Vishnu S. Ravidas ◽  
Samadarsi P. ◽  
Ajayan G.
Keyword(s):  
Peripheral Neuropathy ◽  
Peripheral Arterial Disease ◽  
Diabetic Foot ◽  
Diabetic Peripheral Neuropathy ◽  
Arterial Disease ◽  
Major Amputation ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
The Mean ◽  
Peripheral Arterial

Background: The present study was conducted to determine the association of sociodemographic parameters, comorbid conditions and complications of diabetes mellitus (DM) with the treatment outcomes of diabetic foot ulcers.Methods: The present prospective observational study enrolled 105 participants aged 30-85 years with diabetic foot ulcers presenting to general surgery department during a period of 18 months. Participants who were terminally ill, who had trophic ulcers of Hansen’s disease and filariasis and its sequelae were excluded. The study was approved by institutional ethics committee and written informed consent was obtained from all study participants. Data was analyzed using R and the test of significance was chi square test, p<0.05 was considered statistically significant.Results: Higher proportion of male participants and those aged between 50-69 years were encountered. Male participants were of higher age and the mean duration of DM in participants with diabetic foot ulcer was 8 years. The mean HbA1C of study participants was 8.1%, 38.1% participants had high plasma glucose. Food deformity was observed in 41% participants. 62.9% and 66.7% participants had diabetic peripheral neuropathy and peripheral arterial disease respectively. The mean time required for healing among participants with diabetic foot ulcers was 45.8 Significant association of major amputation with diabetic peripheral neuropathy (p=0.02), Wagner’s grading (p<0.001) and peripheral arterial disease (PAD) (p=0.006) was observed.Conclusions: The presence of diabetic peripheral neuropathy and PAD were risk factors for major amputations in diabetic foot ulcers. Lower Wagner’s grading was associated with lower chances of major amputation.

Sign in / Sign up

Export Citation Format

Share Document