Arterial diseases of lower extremities in diabetic patients: current state and prospects of therapy

Abstract

Peripheral artery diseases (PAD) are most serious diabetic complications responsible for the high risk of amputation of lower extremities. The occurrenceof PAD in diabetic patients is much higher than in subjects with undisturbed carbohydrate metabolism. PAD in diabetic patients is frequentlyan asymptomatic condition affecting distal portions of arterial segments and associated with pronounced mediacalcinosis. Standard diagnostic proceduresfor the screening of arterial lesions must be supplemented by non-invasive visualization and measurement of transcutaneous oxygen tensionin patients at risk of PAD and persisting foot ulcers. Of special importance is early diagnosis of critical limb ischemia and prevention of foot lesions.Combined treatment of diabetic foot syndrome in patients with critical limb ischemia includes normalization of foot circulation, surgical interventionand conservative therapy of the wound, monitoring concomitant micro- and macrovascular diabetic complications?

Diabetic macroangiopathy

“…Медиакальциноз (склероз Менкеберга) -обызвествление средней оболочки артерий на фоне ее утолщения и склероза -возрастает с возрастом от 5% у молодых до 37% у пожилых. У больных СД склероз Менкеберга выявляется в среднем в 3 раза чаще, чем у лиц без нарушений углеводного обмена [22]. Проявления медиакальциноза хорошо видны не только на рентгеновских снимках, но при дуплексном сканировании сосудов нижних конечностей.…”

“…Частота клинически значимых рестенозов составила 12,5%, причем повторные вмешательства успешно осуществлены в 85,4% случаев. За 5-летний период наблюдения сохранение конечности достигнуто в 88% случаев [22].…”

The Effectiveness of Subintimal Balloon Angioplasty in the Treatment of Critical Lower Limb Ischemia in Patients with Diabetes Mellitus

“…Diabetic foot syndrome refers to infection, ulcer and/or destruction of deep tissues associated with neurological disorders and a decrease in the main blood flow in the arteries of the lower extremities of varying severity. Timely diagnosis and treatment of diabetic foot syndrome make it possible to avoid the spread of infection leading to limb amputation and mortality [3,8]. With the development of endovascular technologies, it became possible to improve the blood supply to the soft tissues of the extremities and prevent high amputation.…”