Surgical Revascularization in Chronic Limb-threatening Ischemia in Diabetic Patients

Neagu, C; Buzea, Alexandra; Agache, Alexandra; Georgescu, D.; Pătraşcu, T

doi:10.21614/chirurgia.113.5.668

Cited by 5 publications

(5 citation statements)

References 4 publications

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“…19 The limb salvage rate in our study is comparable to those reported in literature. 12,16 The mean age in our study was 62.4 ±7.3 years and comparable with other studies.…”

Section: Discussionsupporting

confidence: 91%

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Frequency of limb salvage after infra-inguinal bypasses for chronic limb-threatening ischemia in diabetics: a retrospective study

Rehman

2021

J Pak Med Assoc

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Objective: To assess number of limb salvaged among diabetic patients with chronic limb-threatening ischemia after infra-inguinal bypass surgeries at low to middle income country (LMIC) hospital. Methods: It was a retrospective chart review of the diabetic patients who underwent infra-inguinal bypass for lower leg revascularization for chronic limb-threatening ischemia at the Section of Vascular Surgery, Aga Khan University Hospital, Karachi (Pakistan) from Jan 2008 till April 2019. Results: Thirty two patients met the inclusion criteria. The mean age was 62.5 ±7.3 years and 18 (56.3%) were male. Ten (31.3%) patients presented with rest pain, 13(40.6%) with gangrene and 9 (28.1%) patients presented with non-healing ulcer. The most common inflow site was common femoral artery 20 (62.5%). The most frequent outflow sites were above and below knee popliteal arteries; 10 (31.3%) patients each. Twenty (62.5%) patients had suitable veins for reconstruction with autologous graft. The limb salvage rate was 90.6%. Three (9.4%) patients had nonfatal MI. There was no perioperative mortality. Conclusion: Diabetic patients with chronic limb-threatening ischemia had salvage rate of 90.5% after infra-inguinal bypass surgeries in our set up comparable to those described in literature. Keywords: Diabetes mellitus, diabetic foot, arteriopathy, critical limb ischemia, amputation. Continuous...

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“…19 The limb salvage rate in our study is comparable to those reported in literature. 12,16 The mean age in our study was 62.4 ±7.3 years and comparable with other studies.…”

Section: Discussionsupporting

confidence: 91%

“…13 Recent studies have shown excellent results with bypass surgery in diabetics, both in the short and long term. [14][15][16][17] Limb salvage of patients with DM and peripheral vascular disease has been reported to be 85% at one year and 50% at five years. 18 22 (68.7%) of our patients presented with tissue loss similar to other studies.…”

Section: Discussionmentioning

confidence: 99%

Frequency of limb salvage after infra-inguinal bypasses for chronic limb-threatening ischemia in diabetics: a retrospective study

Rehman

2021

J Pak Med Assoc

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“…Limb ischemia caused by diabetic LEAD is not only a factor causing the occurrence of diabetic foot but also an important cause of recurrent and prolonged diabetic foot ulcers [ 16 ]. LEAD in patients with DM has an insidious onset and usually atypical or even asymptomatic clinical symptoms, which makes DM patients and doctors often ignore the presence of LEAD, which makes it difficult to correctly diagnose and evaluate diabetic LEAD [ 17 ]. Therefore, it becomes particularly important for the early screening and assessment of LEAD in T2DM patients.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Short-Term Insulin Pump for Treatment of Patients with Type 2 Diabetes Mellitus Complicated with Lower Extremity Arterial Disease in Endocrinology by Ultrasonography

Guo

Chen

2022

Computational and Mathematical Methods in Medicine

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This research aimed to explore the curative effect of short-term insulin pump in the treatment of type 2 diabetes mellitus (T2DM) patients with lower extremity arterial disease (LEAD) based on ultrasonography. 422 patients (220 males and 202 females) with T2DM in the hospital were selected, and they were randomly divided into control group ( n = 211 , oral hypoglycemic drugs or diet control, appropriate exercise to lower blood glucose) and experimental group ( n = 211 , insulin pump was used to reduce blood glucose). After 2 weeks, the therapeutic effect was evaluated by ultrasonography. The results showed that after two weeks of treatment, the difference in lumen intima between the two groups was statistically significant ( P < 0.05 ). The intima-media thickness (IMT) values of the experimental group were 0.83 ± 0.03 mm , 0.62 ± 0.03 mm , and 0.41 ± 0.04 mm , respectively, which were significantly different from those of the control group ( 1.62 ± 0.54 mm , 1.23 ± 0.14 mm , and 0.78 ± 0.11 mm ) ( P < 0.05 ). There was obvious difference in low-density lipoprotein cholesterol (LDL-C) level between the experimental group ( 2.22 ± 0.46 mmol / L ) and the control group ( 3.21 ± 0.62 mmol / L ) ( P < 0.05 ). The LEAD score of the experimental group was 5.51 ± 1.11 , which was significantly different from that of the control group ( 7.08 ± 2.73 ) ( P < 0.05 ). There was clear difference in LEAD score between the two groups under different course of disease (CD) ( P < 0.05 ). Studies indicated that short-term application of insulin pump therapy could effectively improve the pathological changes of lower limbs in patients with T2DM, which had clinical application value.

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“…The decision regarding the optimal revascularization method for CLTI in patients with DFU should be assessed with respect to distribution of arterial occlusion (as described by the new Global Limb Anatomical Staging System—GLASS [ 21 ]) and by local expertise [ 23 ]. Mostly proximal or very long occlusions should be considered for a surgical approach [ 24 ]. Even though very advanced revascularization techniques are available, there are still some CLTI patients who are not eligible for any kind of standard procedures and are at high risk of imminent major amputation [ 25 ].…”

Section: Guidelines For Use Of Act In People With Diabetesmentioning

confidence: 99%

Cell Therapy of Severe Ischemia in People with Diabetic Foot Ulcers—Do We Have Enough Evidence?

Dubský,

Husáková,

Sojáková

et al. 2023

Mol Diagn Ther

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This current opinion article critically evaluates the efficacy of autologous cell therapy (ACT) for chronic limb-threatening ischemia (CLTI), especially in people with diabetes who are not candidates for standard revascularization. This treatment approach has been used in ‘no-option’ CLTI in the last two decades and more than 1700 patients have received ACT worldwide. Here we analyze the level of published evidence of ACT as well as our experience with this treatment method. Many studies have shown that ACT is safe and an effective method for patients with the most severe lower limb ischemia. However, some trials did not show any benefit of ACT, and there is some heterogeneity in the types of injected cells, route of administration and assessed endpoints. Nevertheless, we believe that ACT plays an important role in a comprehensive treatment of patients with diabetic foot and severe ischemia.

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Surgical Revascularization in Chronic Limb-threatening Ischemia in Diabetic Patients

Cited by 5 publications

References 4 publications

Frequency of limb salvage after infra-inguinal bypasses for chronic limb-threatening ischemia in diabetics: a retrospective study

Frequency of limb salvage after infra-inguinal bypasses for chronic limb-threatening ischemia in diabetics: a retrospective study

Evaluation of Short-Term Insulin Pump for Treatment of Patients with Type 2 Diabetes Mellitus Complicated with Lower Extremity Arterial Disease in Endocrinology by Ultrasonography

Cell Therapy of Severe Ischemia in People with Diabetic Foot Ulcers—Do We Have Enough Evidence?

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