Cormier J M, Cormier F, Fichelle J M, Marzelle J
Centre de pathologie vasculaire, Clinique de La Défense, Nanterre.
Rev Prat. 1995 Jan 1;45(1):50-5.
Lower limb arterial disease in diabetics resembles that in non diabetics. However, some important differences include the vessels involved and the extent of the involvement. In the diabetic, the arteries most frequently involved are those below the knee. Arterial occlusions are bilateral, multisegmental, and involve unusual vessels such as the internal iliac artery, the deep femoral artery, the small branches and the collateral circulation. Arterial disease in the diabetic appears at a younger age, advances more rapidly, is more diffuse, and is almost as common in women as in men. Interaction of arterial disease, neuropathy and infection produces a wide away of clinical findings, including callus formation, foot ulcers, cellulitis, osteomyelitis and patchy areas of gangrene. Foot abscess and cellulitis require emergency debridement and drainage. Arterial reconstruction, including endovascular procedures, lessen the rate of amputation, allow partial foot amputation, and prevent from recurrent foot ulcer. Soft tissue repair, and especially fasciocutaneous flaps or musculocutaneous flaps, provide the means to heal most of the patients without infection, and avoid below-knee amputation.
糖尿病患者的下肢动脉疾病与非糖尿病患者的相似。然而，一些重要的差异包括受累血管及受累程度。在糖尿病患者中，最常受累的动脉是膝以下的动脉。动脉闭塞是双侧、多节段的，且累及不常见的血管，如髂内动脉、股深动脉、小分支及侧支循环。糖尿病患者的动脉疾病发病年龄较轻，进展更快，更弥漫，在女性中的发病率几乎与男性相同。动脉疾病、神经病变和感染相互作用产生了各种各样的临床表现，包括胼胝形成、足部溃疡、蜂窝织炎、骨髓炎和散在的坏疽区域。足部脓肿和蜂窝织炎需要紧急清创和引流。动脉重建，包括血管腔内操作，可降低截肢率，允许进行部分足部截肢，并防止足部溃疡复发。软组织修复，尤其是筋膜皮瓣或肌皮瓣，为大多数患者提供了无感染愈合的方法，并避免膝下截肢。
