J Korean Foot Ankle Soc.  2018 Mar;22(1):32-37. 10.14193/jkfas.2018.22.1.32.

Usefulness of Percutaneous Transluminal Angioplasty before Operative Treatment in Diabetic Foot Gangrene

• Im CS
• Lee MJ
• Kang JM
• Cho YR
• Jo JH
• Lee CS

• KMID: 2407373
• DOI: http://doi.org/10.14193/jkfas.2018.22.1.32

Abstract

PURPOSE
Diabetic foot gangrene has a high morbidity rate and a great influence on the quality of life. Amputation is an appropriate treatment if conservative treatment is impossible according to the severity of gangrene and infection. The purpose of this study was to evaluate the usefulness of preoperative percutaneous transluminal angioplasty for the postoperative outcome.
MATERIALS AND METHODS
From February 2013 to April 2016, among 55 patients with diabetic foot gangrene, who require surgical treatment, percutaneous transluminal angioplasty was performed on patients with an ankle brachial index (0.9 and stenosis) 50% on angiographic computed tomography. The study subjects were 49 patients, comprised of 37 males (75.5%) and 12 females (24.5%). The mean age of the patients was 70.0±9.6 years. The treatment results were followed up according to the position and length of the lesion and the changes during the follow-up period.
RESULTS
As a result of angiography, there were 13 cases of atherosclerotic lesions in the proximal part, 11 cases in the distal part and 25 cases in both the proximal and distal parts. As a result of the follow-up after angiography, in 13 patients, the operation was not performed and only follow-up and dressing were performed around the wound. Sixteen patients underwent debridement for severe gangrene lesions and 20 patients, in whom the gangrene could not be treated, underwent amputation (ray amputation or metatarsal amputation, below knee amputation).
CONCLUSION
Preoperative percutaneous angioplasty in diabetic foot gangrene patients with peripheral vascular occlusive disease is simple, and 59.2% of the patients with diabetic foot gangrene could be treated by conservative treatment or debridement.

Keyword

Diabetic foot; Angioplasty; Gangrene

MeSH Terms

Amputation
Angiography
Angioplasty*
Ankle Brachial Index
Bandages
Debridement
Diabetic Foot*
Female
Follow-Up Studies
Gangrene*
Humans
Knee
Male
Metatarsal Bones
Quality of Life
Wounds and Injuries

Figure

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  Figure 1. Angiography before (A) and after (B) intervention of anterior tibial artery and superficial femoral arteries. Blood flow was restored after the intervention.

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  Figure 2. (A) Diabetic gangrene with ischemia and infection. (B) Fourteen days after balloon dilatation of peripheral artery.

Reference

1.Reiber GE., Lemaster JW. Epidemiology and economic impact of foot ulcers and amputations in people with diabetes. Bowker JH, Pfeifer MA, editors. editors.Levin and O’Neal’s the diabetic foot. 7th ed.Philadelphia: Mosby;2008. p. 3–22.

2.LoGerfo FW., Gibbons GW., Pomposelli FB Jr., Campbell DR., Miller A., Freeman DV, et al. Trends in the care of the diabetic foot. Expanded role of arterial reconstruction. Arch Surg. 1992. 127:617–20. discussion 620-1.

3.Rosenblum BI., Pomposelli FB Jr., Giurini JM., Gibbons GW., Freeman DV., Chrzan JS, et al. Maximizing foot salvage by a combined approach to foot ischemia and neuropathic ulceration in patients with diabetes. A 5-year experience. Diabetes Care. 1994. 17:983–7.

4.Faglia E., Favales F., Quarantiello A., Calia P., Brambilla G., Ram-poldi A, et al. Feasibility and effectiveness of peripheral percutaneous transluminal balloon angioplasty in diabetic subjects with foot ulcers. Diabetes Care. 1996. 19:1261–4.

5.Hanna GP., Fujise K., Kjellgren O., Feld S., Fife C., Schroth G, et al. Infrapopliteal transcatheter interventions for limb salvage in diabetic patients: importance of aggressive interventional ap- proach and role of transcutaneous oximetry. J Am Coll Cardiol. 1997. 30:664–9.

6.Boulton AJ., Vileikyte L., Ragnarson-Tennvall G., Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005. 366:1719–24.

7.Beach KW., Bedford GR., Bergelin RO., Martin DC., Vandenberghe N., Zaccardi M, et al. Progression of lower-extremity arterial occlusive disease in type II diabetes mellitus. Diabetes Care. 1988. 11:464–72.

8.Levin ME. Preventing amputation in the patient with diabetes. Diabetes Care. 1995. 18:1383–94.

9.Gaspar L., Komornikova A., Kruzliak P., Rodrigo L., Gabbasov Z., Staffa R. Contribution of prostaglandin E1 treatment in patients with critical limb ischemia. Int J Clin Exp Med. 2016. 9:3227–31.

10.Flynn MD. The diabetic foot. Tooke JE, editor. editor.Diabetic angiopathy. London: Arnold;1999. p. 92–8.

11.Caputo GM., Cavanagh PR., Ulbrecht JS., Gibbons GW., Karchmer AW. Assessment and management of foot disease in patients with diabetes. N Engl J Med. 1994. 331:854–60.

12.Ouriel K., Fiore WM., Geary JE. Limb-threatening ischemia in the medically compromised patient: amputation or revascularization? Surgery. 1988. 104:667–72.

13.Choi D., Pyun WB., Yoon YS., Jang Y., Shim WH. Frequency of combined atherosclerotic disease of the coronary, periphery, and carotid arteries found by angiography. Korean Circ J. 1999. 29:883–90.

14.Wolosker N., Nakano L., Duarte FH., De Lucia N., Leao PP. Peroneal artery approach for angioplasty of the superficial femoral artery: a case report. Vasc Endovascular Surg. 2003. 37:129–33.

15.Han SH., Park YC. Amputation in diabetic foot ulcer and infection. J Korean Foot Ankle Soc. 2014. 18:8–13.