Vouillarmet J, Bourron O, Gaudric J, Lermusiaux P, Millon A, Hartemann A
Department of endocrinology, diabetes and nutrition, hospices civils de Lyon, centre hospitalier Lyon sud, 69495 Pierre-Bénite, France.
Department of endocrinology, nutrition, and diabetes, AP-HP, 75013 Paris, France; Sorbonne universités, 75005 Paris, France; Inserm UMR_S 1138, centre de recherche des Cordeliers, 75005 Paris, France; Institute of cardiometabolism and nutrition, 75013 Paris, France.
Diabetes Metab. 2016 Feb;42(1):4-15. doi: 10.1016/j.diabet.2015.05.004. Epub 2015 Jun 10.
The presence of peripheral arterial disease (PAD) is an important consideration in the management of diabetic foot ulcers. Indeed, arteriopathy is a major factor in delayed healing and the increased risk of amputation. Revascularization is commonly performed in patients with critical limb ischaemia (CLI) and diabetic foot ulcer (DFU), but also in patients with less severe arteriopathy. The ulcer-healing rate obtained after revascularization ranges from 46% to 91% at 1 year and appears to be improved compared to patients without revascularization. However, in those studies, healing was often a secondary criterion, and there was no description of the initial wound or its management. Furthermore, specific alterations associated with diabetes, such as microcirculation disorders, abnormal angiogenesis and glycation of proteins, can alter healing and the benefits of revascularization. In this review, critical assessment of data from the literature was performed on the relationship between PAD, revascularization and healing of DFUs. Also, the impact of diabetes on the effectiveness of revascularization was analyzed and potential new therapeutic targets described.
外周动脉疾病（PAD）的存在是糖尿病足溃疡治疗中的一个重要考量因素。事实上，动脉病变是愈合延迟和截肢风险增加的主要因素。血管重建术通常用于治疗严重肢体缺血（CLI）和糖尿病足溃疡（DFU）患者，病情较轻的动脉病变患者也适用。血管重建术后1年的溃疡愈合率在46%至91%之间，与未进行血管重建术的患者相比，愈合情况似乎有所改善。然而，在这些研究中，愈合往往是次要标准，且未对初始伤口或其处理进行描述。此外，与糖尿病相关的特定改变，如微循环障碍、异常血管生成和蛋白质糖基化，可影响愈合及血管重建的益处。在本综述中，对文献数据进行了批判性评估，以探讨PAD、血管重建与DFU愈合之间的关系。此外，分析了糖尿病对血管重建效果的影响，并描述了潜在的新治疗靶点。
