Abstract
For the treatment of critical limb ischemia, collaboration with wound specialists and cardiologists performing revascularization is important. The foot care unit affiliated with related departments opened at our hospital in July 2010 for limb salvage, mainly under the leadership of the departments of cardiovascular internal medicineand plastic surgery. We have treated 194 patients up until October 2012. The primary diseases included 81 cases (87 limbs) of foot ulcer and gangrene, with complications of peripheral arterial diseases (PADs) in all cases. Intravascular treatment was conducted for 69 limbs with PAD complications, and the initial success rate was 85.5%, of which surgical debridement or minor amputation was performed on 32 limbs. Regarding open wounds following operation and chronic ulcer, platelet-rich plasma therapy was conducted in 29 limbs and negative pressure wound therapy in 15 limbs. Among all of the patients treated, 58 limbs healed, 10 cases died, and the others are currently receiving ongoing treatment. Cardiovascular internal medicine specialists and plastic surgeons examine patients together at the outpatient clinic and prepare and implement a multidisciplinary treatment plan including vascular reconstructions and operation. We cooperate with physicians in each related department and efforts in team medicine have been made for the purpose of limb salvage.
Highlights
In Japan, as the number of patients with diabetes mellitus and patients undergoing dialysis increases, the number of patients with peripheral arterial disease (PAD) or critical limb ischemia (CLI) is increasing
Treatment with minimal invasion is desirable for patients with CLI; in a large proportion of patients with CLI, it is difficult to perform surgery because of complications; there are an insufficient number of vascular surgeons who perform peripheral bypass surgery; and because of these reasons, our hospital has performed endovascular treatment (EVT) as the first option
Minor amputation or debridement was performed on 32 limbs after EVT, and major amputation was performed on 7 limbs of all patients with CLI
Summary
In Japan, as the number of patients with diabetes mellitus and patients undergoing dialysis increases, the number of patients with peripheral arterial disease (PAD) or critical limb ischemia (CLI) is increasing. Treatment with minimal invasion is desirable for patients with CLI; in a large proportion of patients with CLI, it is difficult to perform surgery because of complications; there are an insufficient number of vascular surgeons who perform peripheral bypass surgery; and because of these reasons, our hospital has performed endovascular treatment (EVT) as the first option. EVT has made remarkable progress, and it can be performed repeatedly with minimal invasion in patients in whom bypass surgery is not indicated because of reasons such as poor systemic condition; endovascular treatment has been increasingly performed in many patients. It has been reported that there is no difference in limb salvage rate between EVT and bypass surgery, but that a long-term patency cannot be expected by EVT, and that a patency of only 1 of 3 branches
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