scholarly journals RISK FACTORS FOR DIABETIC FOOT AND LOWER LIMB AMPUTATION

2019 ◽  
Vol 3 (9) ◽  
Author(s):  
Dr. Uday Prakash ◽  
Dr. Kumar Durgeshwar ◽  
Dr.R.K. Das ◽  
Dr. Lalji Chaudhary
Keyword(s):  
Risk Factors ◽  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Diabetic Foot ◽  
Arterial Disease ◽  
Major Amputation ◽  
Cardiac Diseases ◽  
Foot Ulceration ◽  
Duration Of Diabetes ◽  
Peripheral Arterial

Introduction: Diabetic foot syndrome (DFS) is the major cause of hospitalization for diabetes-related complications. Protective sensation loss and impaired vision increase the susceptibility for minor feet trauma, which results in diabetic foot ulceration with or without subsequent infection. Peripheral arterial disease is a major cause of impaired ulcer, wound healing and gangrenous diabetic foot. The most important intervention to prevent diabetic foot ulceration and its consequences is early recognition of high-risk patients and their risk factors and referral to appropriate medical departments. There are various risk factors for major lower extremity amputations related to diabetic foot, which includes microvascular diseases, infections, long duration of diabetes, poor glycemic control, peripheral arterial disease, old age and associated cardiovascular comorbidities. Material and Methods: This study was done on the review of medical records of consecutive type 2 diabetic patients. Admitted patients were treated and managed according to the standard protocol of the hospital. History, clinical and physical examination were carried out on each patient. Ulcer characteristics like infection and depth of the ulcer, site of ulcer were assessed. Associated diabetic neuropathy and peripheral arterial disease was assessed by a clinical method. Age, sex, body mass index (BMI), smoking, duration of diabetes, diabetic control therapy, associated hypertension, cardiac diseases were recorded. The glycated haemoglobin level (HbA1c) were recorded. Results: A total of 128 patients with diabetic foot were included in the study of which 76(59.4%) were male and 52(40.6%) were female. Of the 76 male 6 (4.7%) had major amputation and out of 52 female 4(3.1%) had major amputation, thus total number of major amputations were 10(7.8%). Statistically significant difference was observed in HbA1C and duration of diabetes group in amputation. High HbA1C and more duration of diabetes was associated with the higher number of amputation. The rate of amputation was much higher among patients hypertension, smoking, cardiac diseases and stroke. Conclusion: Poor glycemic controls and duration of diabetes are the important independent risk factors for diabetes-related major lower extremity amputations. Keywords: DFS, BMI, smkoing, DM

Peripheral Arterial Disease in Persons with Diabetic Foot Ulceration: a Current Comprehensive Overview

2020 ◽  
Vol 16 ◽  
Author(s):  
Meloni Marco ◽  
Izzo Valentina ◽  
Morosetti Daniele ◽  
Da Ros Valerio ◽  
Panunzi Andrea ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Diabetic Foot ◽  
Limb Ischemia ◽  
Developed Countries ◽  
Arterial Disease ◽  
Major Amputation ◽  
Comprehensive Overview ◽  
Foot Ulceration ◽  
Cardiovascular Morbidity And Mortality ◽  
Peripheral Arterial

-: In developed countries, the prevalence of persons with diabetes and peripheral arterial disease (PAD) is approximately 50%. The presence of PAD is associated with non-healing ulcers, major amputation, cardiovascular morbidity, and mortality. It is estimated that 50% of persons with diabetes, foot ulceration and PAD have a 5-year mortality rate . Therefore, subjects with ischemic diabetic foot ulcers (DFUs) should be considered a special group of patients with specific clinical characteristics, general health status and prognosis. -: In persons with ischemic DFUs, an early diagnosis and treatment is mandatory to reduce the risk of worse outcomes such as major amputation. Revascularization of occluded lower extremity arteries is the main treatment to restore blood flow in the foot and promote wound healing. Nonetheless, there are several unmet needs in the management of diabetic subjects with PAD and foot ulceration as medical therapy, diagnostic criteria and indications for revascularization, revascularization strategy and technical approach as well as the management of no-option critical limb ischemia patients. -: Furthermore, it is a common opinion that there is an evolution of PAD features in diabetic persons which seem to present a more aggressive pattern. This may be related to the frequent presence of concomitant comorbidities such as renal failure which could influence the characteristics of atherosclerotic plaques and their distribution. -: The aim of this review is to commence a complete overview and state of the art in the treatment of patients with diabetes, PAD, and foot ulceration and to describe the current challenges and future perspectives.

Abstract P250: Incidence of Hospitalized Peripheral Arterial Disease and Critical Limb Ischemia: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Corey A Kalbaugh ◽  
Anna Kucharska-Newton ◽  
Laura Loehr ◽  
Elizabeth Selvin ◽  
Aaron R Folsom ◽  
...  
Keyword(s):  
Risk Factors ◽  
African Americans ◽  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Baseline Characteristics ◽  
Peripheral Arterial

Introduction: Lower extremity peripheral arterial disease (PAD) affects between 12% and 20% of Americans over the age of 65. PAD compromises quality of life, contributes a high burden of disability and its related health care costs exceed $4 billion/year, yet this preventable CVD outcome remains understudied. Aims: Assess the incidence of hospitalized PAD, and of the most severe form of PAD, critical limb ischemia (CLI), in middle-aged men and women, and evaluate their risk factors in a bi-ethnic, population-based cohort. We hypothesized that incidence of hospitalized PAD and CLI are higher in African Americans, and that modifiable atherosclerosis risk factors in middle age predict these sequelae of PAD. Methods: We analyzed data from 13,865 participants from the Atherosclerosis Risk in Communities Study aged 45–64 without PAD at baseline (1987–89). Incident PAD and CLI events were identified using ICD-9 codes from active surveillance of all hospitalizations among cohort participants from 1987 through 2008. All estimates are incidence rates per 10,000 person-years; nominal statistical significance was achieved for all baseline characteristic comparisons reported. Results: There were 707 incident hospitalized PAD during a median of 18 years of follow-up (249,570 person-years). The overall age-adjusted incidence of PAD and limb-threatening CLI were 26.0 and 9.6 per 10,000 person-years, respectively. Incidence of hospitalized PAD was higher in African Americans than whites (34.7 vs. 23.2) and in men compared to women (32.4 vs. 26.7). Baseline characteristics associated with age-adjusted incident PAD (per 10,000 person-years) compared to their referent groups were diabetes (91.2 vs. 19.0), history of smoking (33.6 vs. 16.2), hypertension (42.6 vs. 18.6), coronary heart disease (81.4 vs. 24.1), and obesity (41.5 vs. 20.2). Incidence of CLI also was higher among African Americans (21.0 vs. 5.9) and in men (10.5 vs. 8.9 per 10,000 person-years). Baseline characteristics associated with incident CLI were similar to those for PAD. Conclusions: The absolute risk of hospitalized lower extremity PAD in this community-based cohort is of a magnitude similar to that of heart failure and of stroke. As modifiable factors are strongly predictive of the long-term risk of hospitalized PAD and CLI, particularly among African Americans, our results highlight the need for effective risk factor prevention and control.

Risk factors for wound complications and 30-day mortality after major lower limb amputations in patients with peripheral arterial disease

Vascular ◽  
2017 ◽  
Vol 26 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Koichi Morisaki ◽  
Terutoshi Yamaoka ◽  
Kazuomi Iwasa
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Major Amputation ◽  
Hazard Ratio ◽  
Wound Complications ◽  
Albumin Concentration ◽  
Knee Amputation ◽  
Peripheral Arterial

Purpose Risk factors for wound complications or 30-day mortality after major amputation in patients with peripheral arterial disease remain unclear. We investigated the outcomes of major amputation in patients with peripheral arterial disease. Methods Patients who underwent major amputation from 2008 to 2015 were retrospectively analyzed. The main outcome measures were risk factors for wound complications and 30-day mortality after major lower limb amputations. Major amputation was defined as above-knee amputation or below-knee amputation. Wound complications were defined as surgical site infection or wound dehiscence. Results In total, 106 consecutive patients underwent major amputation. The average age was 77.3 ± 11.2 years, 67.9% of patients had diabetes mellitus and 35.8% were undergoing hemodialysis. Patients who underwent primary amputation constituted 61.9% of the cohort, and the proportions of above-knee amputation and below-knee amputation were 66.9% and 33.1%, respectively. The wound complication rate was 13.3% overall, 10.3% in above-knee amputation, and 19.5% in below-knee amputation. Multivariate analysis showed that the risk factors for wound complications were female sex (hazard ratio, 4.66; 95% confidence interval, 1.40–17.3; P = 0.01) and below-knee amputation (hazard ratio, 4.36; 95% confidence interval, 1.20–17.6; P = 0.03). The 30-day mortality rate was 7.6%, pneumonia comprised the most frequent cause of 30-day mortality, followed by sepsis and cardiac death. Multivariate analysis showed that a low serum albumin concentration (hazard ratio, 3.87; 95% confidence interval, 1.12–16.3; P = 0.03) was a risk factor for 30-day mortality. Conclusions Female sex and below-knee amputation were risk factors for wound complications. A low serum albumin concentration was a risk factor for 30-day mortality after major amputation in Japanese patients with peripheral arterial disease.

scholarly journals Improving major amputation rates in the multicomplex diabetic foot patient: focus on the severity of peripheral arterial disease

2013 ◽  
Vol 4 (3) ◽  
pp. 83-94 ◽  
Author(s):  
Andrej Brechow ◽  
Torsten Slesaczeck ◽  
Dirk Münch ◽  
Thomas Nanning ◽  
Hartmut Paetzold ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Diabetic Foot ◽  
Arterial Disease ◽  
Major Amputation ◽  
Peripheral Arterial

scholarly journals Study prevalence of peripheral arterial disease in diabetics with coronary artery disease at a large tertiary care teaching hospital in North India

2020 ◽  
Vol 8 (2) ◽  
pp. 720
Author(s):  
Sajad Hussain Bhat ◽  
Mohd Yousuf Dar ◽  
Aadil Majeed
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Family History ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Duration Of Diabetes ◽  
Co Morbidity ◽  
Artery Disease ◽  
Peripheral Arterial

Background: Peripheral arterial disease and coronary artery disease have similar factors. The extent and severity of PAD is significantly associated with presence and severity of CAD.Methods: Patients were interviewed and clinical profile of patients including risk factors of coronary artery disease like diabetes, hypertension, smoking, dyslipidemia, obesity and family history of coronary artery disease were assessed and recorded in the proforma. Information regarding demographics, co morbidity, past history and family history was collected. Physical examination of each patient was carried and basic anthropometric data: height, weight, BMI and blood pressure, peripheral pulses calculated. Investigations both non- invasive and invasive including peripheral angiography were recorded.Results: In this prospective study fifty (50) type 2 diabetes patients admitted with CAD were studied whose mean age was 55.6+8.2 and mean duration of diabetes was 6.8+8.4. In this study none of the patients with PAD had single atherosclerosis risk factors including diabetes. 30% patients were having two risk factors. PAD in in patients with CAD is particularly enhanced by the concomitant occurrence of two or more of these risk factors (p=0.016). Hypertension as a predictor of PAD was statistically significant (p=0.0037). In this study the duration of diabetes was <5 years in 10%, 5-10 years in 40% and >10 years in 40% of patients with angiographically proven PAD.Conclusions: It was observed that presence and severity CAD was significantly associated with PAD.

Sign in / Sign up

Export Citation Format

Share Document