CHOICE OF REVASCULARIZATION TECHNIQUE IN PATIENTS WITH ISCHEMIC DIABETIC FOOT

Abstract

Background
 Ischemic diabetic foot is determined by trophic disorders of the foot due to a combination of atherosclerosis of the arteries and diabetic lesions. In the United States and some European countries, among major non-traumatic amputations, amputations in patients with diabetes are 45-70%. The use of revascularization can significantly improve the results of treatment of patients with diabetic foot. Features of ischemic diabetic foot require a separate approach to revascularization. There are no generally accepted guidelines for revascularization in diabetic foot in the world today. The choice of revascularization technique remains an open question.
 The aim of the study.
 To analyze the effectiveness of differentiated application of intervention techniques of revascularization for the treatment of ischemic diabetic foot.
 Steps of differentiated choice of revascularization
 We identified seven steps: determination of indications for revascularization,
 determination of the critical arterial segment. the level of hemodynamic compensation, determination of the feasibility of revascularization, the choice of revascularization technique, the perform revascularization, the active postoperative monitoring.
 Materials and methods
 Diabetic ischemic foot was diagnosed in 133 observations. 123 revascularizations of 94 lower extremities were performed in 91 patients with ischemic diabetic foot. Patients underwent angioplasty, surgical revascularization or hybrid intervention.
 Results
 Revascularization was performed in revascularization was performed in 92,4% of patients with ischemic diabetic foot. Amputation-free survival was noted in 85.4% of cases, wound-healing in 62.6%, preservation of foot support function in 79.7%, avoidance of repeated interventions in 78.9%. 5 (5.5%) patients died, 2 of them (2.2:%) within 30 days after revascularization.
 Conclusions: Differentiated choice of revascularization technique allows to increase the number of patients to be revascularized 92,4%, to reach of the level amputation-free survival to 85,4%, to reach of the level wound-healing to 62,6%, to salvage of foot support function to 79,7%, to perform revascularizations in patients with a high probability of limb amputation.