Cormier J M, Cormier F, Fichelle J M, Arzelle J M, Trevidic P
Clinique de la Défense, Nanterre.
Chirurgie. 1996;121(2):133-6.
Diabetic arteriopathy is a specific entity as it associates macro-angiopathy ischemia factor and micro-angiopathy leading to peripheral neuropathy. This association leads to specific clinical manifestations dues to interplay of ischemic and infectious phenomena. Diffuse occlusive lesions predominate distally with mediacalcosis. Wider surgical indications for revascularization of distal vessels of the leg, the ankle and the foot have reduced the number and extent of amputation. Long-term permeability after salvage surgery is identical to that in non-diabetic patients as shown by our series of 695 distal revascularizations. Endovascular techniques with or without stents or recanalization are alternatives which may be indicated in case of short occlusions or trophic disorders contraindicating surgery. Associating stents with conventional surgery may also be indicated in diabetic patients. One final progress in reducing the number of amputations has been provided by free-transfer micro-surgery techniques which allow both vascular supply and coverage of distal tissue loss.
糖尿病性动脉病是一种特殊的病症，因为它与宏观血管病变缺血因素以及导致周围神经病变的微血管病变相关联。这种关联由于缺血和感染现象的相互作用而导致特定的临床表现。弥漫性闭塞性病变以远端伴有中膜钙化为主。对于腿部、踝部和足部远端血管进行血管重建的更广泛手术指征减少了截肢的数量和范围。如我们695例远端血管重建系列所示，挽救手术后的长期通畅率与非糖尿病患者相同。有或没有支架或再通的血管内技术是在短闭塞或营养障碍禁忌手术的情况下可能适用的替代方法。在糖尿病患者中，将支架与传统手术相结合也可能是适用的。游离组织移植显微外科技术为减少截肢数量带来了最后的进展，该技术既能够提供血管供应，又能够覆盖远端组织缺损。
