Results of treatment of diabetic patients with chronic critical ischemia of the lower limb
Background. In Ukraine, the current shortage of qualified vascular surgical care, especially for diabetic people, remains relevant. The diabetic patients with chronic critical ischemia of the lower limb often undergo unreasonable conservative treatment in conditions of a general surgical hospital with an unsatisfactory result. The purpose of the work is to compare the results of conservative treatment with the results of endovascular and open surgical interventions in patients with diabetes mellitus and chronic critical ischemia of the lower limb. Materials and methods. The results of surgical treatment of 240 type 2 diabetes patients with chronic critical ischemia of the lower extremity were analyzed. Group A1 included 42 (17.5 %) patients who had shunting in the artery of the lower leg or feet. The group A2 consisted of 101 (42.1 %) patients with balloon angioplasty. Group B contained 97 (40.4 %) patients received conservative therapy. In order to correctly compare the results of different types of treatment, we developed a technique for calculating of the coefficient of amputation level. Results. Among 42 patients in the group A1, 4 (9.5 %) patients had amputation at the thigh, 3 (6.7 %) — at the level of the leg, 6 (14.3 %) — transmetatarsal resection of the foot, 14 (33.3 %) — amputation of fingers, in 15 (35.7 %) patients the support function of the foot was not impaired. The coefficient of amputation level in A1 group was 1.48. Among 101 patients in the group A2, 2 (2 %) had amputation at the thigh, 4 (4 %) — at the level of the leg, 16 (16 %) — transmetatarsal foot resection, and 19 (19%) — amputation of the fingers, in 60 (60%) patients the support function of the foot was not impaired. The coefficient of amputation level in A2 group was 0.78. Among 97 patients in group B, 22 (22.7 %) had amputation at hip level, 29 (29.9%) — at the level of the leg, 6 (6.2 %) — transmetatarsal foot resection, 11 (11.3 %) — amputation of fingers, in 29 (29.9 %) patients the support function of the foot was not impaired. The coefficient of amputation level in the group B was 2.79. Conclusions. The presented coefficient of amputation level calculation technique can be used to compare the treatment outcomes in the groups of diabetic patients with chronic critical ischemia of the lower limb against the background of stenotic-occlusive lesions of the arteries of the popliteo-cruro-pedal segments treated with various therapeutic methods. The best annual results of the support function of the foot were observed in A2 group patients. The worst annual results were observed in group B patients received conservative treatment.
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Zaremba VS, Myskiv AV, Kopyljuk JuI. New approach to treatment of ischemic form of diabetic foot syndrome. Clinical Pharmacy, Pharmacotherapy and Medical Standardization. 2011;(10-11):117-122. (in Ukrainian).
Naidoo P, Liu VJ, Mautone M, Bergin S. Lower limb complications of diabetes mellitus: a comprehensive review with clinicopathological insights from a dedicated high-risk diabetic foot multidisciplinary team. Br J Radiol. 2015 Sep;88(1053):20150135. doi: 10.1259/bjr.20150135.
Thiruvoipati T, Kielhorn CE, Armstrong EJ. Peripheral artery disease in patients with diabetes: Epidemiology, mechanisms, and outcomes. World J Diabetes. 2015 Jul 10;6(7):961-9. doi: 10.4239/wjd.v6.i7.961.
Antoniou GA, Sfyroeras GS, Karathanos C, et al. Hybrid, endovascular and open treatment of severe multilevel lower extremity arterial disease. Eur J Vasc Endovasc Surg. 2009 Nov;38(5):616-22. doi: 10.1016/j.ejvs.2009.06.016.
Schaper NC, Andros G, Apelqvist J, et al. Diagnosis and treatment of peripheral arterial disease in diabetic patients with a foot ulcer: a progress report of the International Working Group on the Diabetic Foot. Diabetes Metab Res Rev. 2012 Feb;28 Suppl 1:218-24. doi: 10.1002/dmrr.2255.
Boiko VV, Ibragimov RS. Complex treatment of diabetic foot syndrome. Harkivs'ka hirurgichna shkola. 2009;(3):90-93. (in Russian).
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