Treatment of peripheral arterial disease in diabetes: A consensus of the Italian Societies of Diabetes (SID, AMD), Radiology (SIRM) and Vascular Endovascular Surgery (SICVE)

Aiello, Alessandro; Anichini, Roberto; Brocco, Enrico; Caravaggi, C.; Chiavetta, A; Cioni, Roberto; Ros, Roberto Da; Feo, M. E. De; Ferraresi, Roberto; Florio, F; Gargiulo, Mauro; Galzerano, G; Gandini, Roberto; Giurato, Laura; Graziani, Lanfroi; Mancini, Luca; Manzi, Marco; Modugno, Pietro; Setacci, Carlo; Uccioli, Luigi

doi:10.1016/j.numecd.2013.12.007

Cited by 86 publications

(68 citation statements)

References 132 publications

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“…In diabetic subjects, peripheral arterial disease more frequently affects below-the-knee vessels such as the tibial and peroneal arteries and is symmetric, multi-segmental while the collateral vessels can also be affected by stenosis. 14 Our study has shown that all patients presented with peripheral arterial disease, i.e. underlying tibioperoneal disease (77%).…”

Section: Discussionmentioning

confidence: 70%

Spectrum of disease and outcome of primary amputation for diabetic foot sepsis in rural KwaZulu-Natal

Cheddie

Manneh

Pillay³

2018

S. Afr. j. surg.

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Background: Primary amputation (stump closure) for diabetic foot sepsis is perceived to have a higher re-amputation rate due to stump sepsis. A guillotine amputation with elective stump closure is widely practised due to the lower risk of stump sepsis and re-amputation. Aims: To provide an epidemiological analysis of the spectrum of disease and outcomes of primary amputation for diabetic foot sepsis in a regional rural hospital. Methods: A prospective cohort study of 100 patients who underwent surgery for diabetic foot sepsis over a 5-year period was undertaken at Madadeni Provincial Hospital, in northern KwaZulu-Natal. Demographic data, co-morbid profile, radiographic features, anatomical level of vascular occlusion and type of surgery performed were recorded. The Wagner classification (Wag) was used to classify disease severity. Outcome measures included length of hospital stay, in-hospital mortality and re-amputation rates. Results: Of the 100 patients, females (n = 50) accounted for 50% of admissions. The median age was 61 years (range: 29 to 80 years). Most patients presented with advanced disease: Wag 5, n = 71 (71%); Wag 4, n = 20 (20%); Wag 3, n = 7 (7%); Wag 2, n = 2 (2%). The anatomic levels of vascular occlusion comprised: aortoiliac disease n = 2 (2%), femoropopliteal n=21(21%) and tibioperoneal disease n = 77 (77%). The following surgical procedures were undertaken: above knee amputation (AKA), n = 35 (35%); below knee amputation (BKA), n = 46 (46%); transmetatarsal amputation (TMA), n = 8 (8%); toe ectomy, n = 8 (8%) and debridement, n = 3 (3%). The re-amputation rate to above knee amputation was n = 2/46 (4.3%). All AKA stumps healed completely. The overall in-hospital mortality was n = 7 (7%) and median length of hospital stay was 7.8 ± 3.83 days. Conclusion: Most patients present with advanced disease requiring a major amputation. A definitive one stage primary amputation is a safe and effective procedure for diabetic foot sepsis with distinct advantages of a short hospital stay, low reamputation rates and mortality. A guillotine amputation should be reserved for physiologically unstable patients.

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Section: Discussionmentioning

confidence: 70%

Spectrum of disease and outcome of primary amputation for diabetic foot sepsis in rural KwaZulu-Natal

Cheddie

Manneh

Pillay³

2018

S. Afr. j. surg.

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“…In diabetic pts, PAD is usually symmetrical and multi-segmental and involves arteries below the knee [20]. Moreover, the arterial walls are often calcified and occlusions are more frequent than stenosis [21]. PAD progression, defined as ABI decline >0.15 is significantly associated with both all-cause and CV mortality [22].…”

Section: Epidemiology and Clinical Characteristics Of Padmentioning

confidence: 99%

Diabetes, renal dysfunction, inflammation, and anemia: the deadly quartet in peripheral artery disease

Vrsalović¹,

Vučur²

2016

Endocr oncol metab

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The article reviews the burden of peripheral artery disease (PAD) and its association with diabetes, renal dysfunction, inflammation, and anemia. PAD is a marker of advanced atherosclerotic disease and is associated with a poor quality of life, ischemic events, and mortality. Polyvascular involvement is often observed in PAD patients (pts), and contributes to the greater risk of all-cause and cardiovascular mortality. Diabetes is a major risk factor for PAD, and the presence of PAD in diabetic pts is associated with unfavorable cardiovascular outcomes. In comparison to nondiabetic PAD pts, diabetic pts often have severe forms of PAD such as foot ulcers and gangrene, and more often have involvement of the distal extremities. Diabetes is often accompanied by anemia, particularly in the presence of impaired renal function. Chronic kidney disease and PAD share some common risk factors and frequently coexist. In PAD pts, renal dysfunction has been associated with an increased risk of major adverse cardiovascular events and mortality. Anemia is quite prevalent in PAD pts, especially in those with critical limb ischemia. The severity of anemia has been identified as an independent predictor of limb loss and mortality. C-reactive protein (CRP) is associated with the development of PAD and diabetes. Increased levels of CRP in diabetic pts intensify the risk for PAD development. Data regarding the prognostic role of CRP in PAD pts suggest that CRP is a better prognostic marker for short-term rather than long-term mortality. Considering the close relationship between diabetes, renal dysfunction, inflammation, and anemia in PAD pts, a multidisciplinary approach is needed in order to improve quality of life and prevent ischemic events and fatal outcomes.

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“…In case of significant stenosis or ulcerated plaque, MRI or TC could be help clinician to better define arterial disease and the need of treatment. In fact, carotid stenosis > 70% or ulcerated plaque should be treated before treating limb ischemia [68].…”

Section: Assessment Therapy In Case Of Revascularizationmentioning

confidence: 99%

Medical Management of Acute Foot Injury in Diabetic Patients

Meloni¹

2016

JED

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Treatment of peripheral arterial disease in diabetes: A consensus of the Italian Societies of Diabetes (SID, AMD), Radiology (SIRM) and Vascular Endovascular Surgery (SICVE)

Cited by 86 publications

References 132 publications

Spectrum of disease and outcome of primary amputation for diabetic foot sepsis in rural KwaZulu-Natal

Spectrum of disease and outcome of primary amputation for diabetic foot sepsis in rural KwaZulu-Natal

Diabetes, renal dysfunction, inflammation, and anemia: the deadly quartet in peripheral artery disease

Medical Management of Acute Foot Injury in Diabetic Patients

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