Kota Siva Krishna, Kota Sunil Kumar, Meher Lalit Kumar, Sahoo Satyajit, Mohapatra Sudeep, Modi Kirtikumar Dharmsibhai
Department of Anesthesia, Central Security Hospital, Riyadh, Saudi Arabia.
J Cardiovasc Dis Res. 2013 Jun;4(2):79-83. doi: 10.1016/j.jcdr.2012.10.002. Epub 2013 Jun 18.
Diabetes is an important risk factor for atherosclerosis. The diabetic foot is characterized by the presence of arteriopathy and neuropathy. The vascular damage includes non-occlusive microangiopathy and macroangiopathy. Diabetic foot wounds are responsible for 5-10% of the cases of major or minor amputations. In fact, the risk of amputation of the lower limbs is 15-20% higher in diabetic populations than in the general population. The University of Texas classification is the reference classification for diabetic wounds. It distinguishes non-ischemic wounds from ischemic wounds which are associated with a higher rate of amputation. The first principles of treatment are the control of pain of an eventual infection. When ischemia is diagnosed, restoration of pulsatile blood flow by revascularization may be considered for salvaging the limb. The treatment options are angioplasty with or without stenting and surgical bypass or hybrid procedures combining the two. Distal reconstructions with anastomosis to the leg or pedal arteries have satisfactory limb-salvage rates. Subintimal angioplasty is a more recent endovascular technique. It could be suggested for elderly patients who are believed to be unsuitable candidates for a conventional bypass or angioplasty. The current article would focus on the various revascularization procedures.
糖尿病是动脉粥样硬化的重要危险因素。糖尿病足的特征是存在动脉病变和神经病变。血管损伤包括非闭塞性微血管病变和大血管病变。糖尿病足伤口占大截肢或小截肢病例的5%至10%。事实上，糖尿病患者下肢截肢的风险比普通人群高15%至20%。德克萨斯大学分类是糖尿病伤口的参考分类。它将非缺血性伤口与缺血性伤口区分开来，缺血性伤口的截肢率更高。治疗的首要原则是控制可能发生的感染的疼痛。当诊断出缺血时，可考虑通过血管重建恢复搏动性血流以挽救肢体。治疗选择包括有或无支架置入的血管成形术、外科搭桥手术或两者结合的混合手术。与腿部或足部动脉吻合的远端重建具有令人满意的肢体挽救率。内膜下血管成形术是一种较新的血管内技术。对于被认为不适合传统搭桥手术或血管成形术的老年患者，可以考虑采用该技术。本文将重点介绍各种血管重建手术。
