A complication of Diabetes Mellitus can lead to diabetic foot. It affects patients with Peripheral Neuropathy and Peripheral Artery Disease (PAD). When an ulcer appears, keep in prior to amputation alternative account.
The diabetic foot is a complication of Diabetes Mellitus and affects patients with peripheral neuropathy and / or peripheral arterial disease (PAD). Some patients do not experience the first symptoms of the disease and when this occurs, it is as an ulcer or necrotic tissue. Here is the time to assess properly to avoid amputation.
Experts in Angiology and Vascular Surgery only indicate primary limb amputation if the case of a systemic infection with septic shock (severe infection resulting in a dangerous low blood pressure) or irreversible extensive necrosis of the entire foot. It is clear that amputation is a potentially disabling process, considered worldwide as a significant public health problem.
People with diabetes have a risk of amputation of 20-40 times greater than people without diabetes. Along with diabetic retinopathy (eye complication of diabetes caused by a breakdown of the blood vessels supplying the retina), amputation of a lower limb can be used as an indicator of poor health outcome. In addition, minor or major lower extremity diabetic amputation, and the impact on quality of life, carries a high risk of mortality: approximately 10% die perioperative, at the end of the first year has passed 30% to three years 50% and after five years, mortality rises to 70%.
Alternative techniques to amputation
Most cases of Vascular Surgery service are patients with PAD and ulcers that the need for revascularization (operational alternative to amputation prior) and the method of revascularization is evaluated according to some clinical criteria:
- the potential ulcer healing (reversible / irreversible tissue)
- local foot condition and residual functionality thereof once cured
- vascular anatomy and general condition of the patient
There are also contraindications for revascularization, such as short life expectancy of less than three months, psychiatric disorders, retraction of the knee (chronic antalgic position), chronic "bed rest" and patients who do not ramble.
Regarding the choice of method of revascularization, percutaneous angioplasty (minimally invasive procedure is performed under local anesthesia) is a technically feasible and effective method in patients with PAD. This technique reduces complications and increases the range of the limb salvage of. Furthermore, although the long-term patency is still higher when it comes to bypass, angioplasty is a method that can be repeated if there restenosis or detention (coronary obstruction and reduction), and may even occur if the bypass fails.
It has been shown that in patients with high surgical risk, critical ischemia can be successfully treated with endovascular techniques. The strategy has proven to be well tolerated, with low mortality, lower costs and, above all, a shorter duration of hospital stay. It is especially this last parameter which many studies highlight as the main difference in terms of cost-effectiveness between the two techniques, since patients undergoing conventional surgery lengthen the stay, especially postoperative complications arising from the fact that patients with high co-morbidity.