Revascularization in Diabetic Foot Ulcer and Outcome

Research Article

Austin J Surg. 2021; 8(5): 1280.

Revascularization in Diabetic Foot Ulcer and Outcome

Islam M*

Department of Vascular Surgery, National Institute of Cardiovascular Disease Hospital (NICVD), Bangladesh

*Corresponding author: Moynul Islam, Department of Vascular Surgery, National Institute of Cardiovascular Disease Hospital (NICVD), Bangladesh

Received: September 28, 2021; Accepted: October 23, 2021; Published: October 30, 2021

Keywords

Peripheral arterial disease; Diabetes; Population

Introduction

Diabetes is a major public health problem regionally and globally. In 2019, the International Diabetes Federation estimated that 465 million (9.3%) people worldwide had diabetes, and by 2045, the number may rise to 700 million (10.9%) [1]. The pooled prevalence of diabetes in the general population of Bangladesh is 7.8% and prevalence of pre-diabetes is 10.1% [2].

Diabetes is a complex disease with many serious potential sequelae, including large vessel arterial disease and microvascular dysfunction. The lifetime risk for foot ulcers in people with diabetes is estimated to be 15% [3]. Development of diabetic foot ulcer is attributed to many interacting factors, the most common ones being peripheral neuropathy and Peripheral Arterial Disease (PAD) [4]. PAD is an important precipitating factor in the outcome of diabetic foot ulcer [4]. Peripheral arterial disease is a common large vessel complication of diabetes, implicated in the development of tissue loss in up to half of patients with diabetic foot ulceration [5]. Diabetic patients with PAD commonly show involvement of the arteries below the knee, especially at the tibial and peroneal arteries, and involvement of the profunda femoris [6]. Diabetic ulcers always require vascular evaluation, and when ischaemia is suspected the diagnostics should be organized rapidly to ensure revascularisation without delay. Foot ulcer in patients with diabetes is associated with an increased risk of lower limb amputation, and thus the primary aim of treatment for ischemic foot ulcer is limb preservation [4]. Invasive revascularization, including open reconstructive surgery and/or endovascular intervention, is the most effective treatment that may improve peripheral circulation and remedy symptoms [4]. The basic aim of any successful revascularization is to achieve pulsatile flow to the foot. The two methods currently available are peripheral bypass surgery and peripheral angioplasty [7]. Current literature shows that percutaneous transluminal angioplasty (PTA) is the first choice of procedures in revascularization of the lower limb [7].

Materials and Methods

Prospective study in combined military hospital Dhaka between Jan 2017 to Jan 2020. Total 267 diabetic patient with foot ulcer reported to the cardiovascular surgery department. 192 patients were suspected to have ischaemic ulcer and included in the study.

Patients with foot ulcer, absent pedal pulses and diabetes mellitus, were included in the study. Neuropathic ulcer and venous ulcer with present pedal pulses were excluded from the study.

All patients were evaluated clinically, Ankle-Brachial pressure, toe pressure were measured, and subsequent duplex scan and/or CT angiogram performed. Revascularization was done either by peripheral angiogram and angioplasty/stenting or by open surgery. Adjunctive therapy with local wound care and antibiotics were applied for ulcer. All patients were followed up for at least 01 year.

Results

A total of 192 diabetic patients with foot ulcer and absent pedal pulse were seen during the 3-year recruitment period. Of these, 07 were lost after the first observation. The other 185 were included in our study (mean follow-up 18 +/- 8 months [range 1-42 months])