Progress in surgical treatment of lower limb ischemia in diabetes in China / 中国医师杂志

ABSTRACT

Diabetes is one of the common diseases in China. About 15% to 25% of people with diabetes develop diabetic foot, which in severe cases can lead to amputation. Diabetic lower limb ischemia is the main cause of diabetic foot, and reconstruction of blood flow through surgery is an important treatment method for diabetic lower limb ischemia. Lower extremity arterial bypass graft is a classic open surgery for the treatment of diabetic lower limb ischemia. Although the application of arterial bypass graft has gradually decreased, it is still a reliable treatment option for some specific patients. Endovascular therapy has been the first-line surgical treatment for diabetic lower extremity ischemia, of which balloon angioplasty is the basic method and is now commonly used as an approach of vascular preparation. Debulking atherectomy is another important way for vascular preparation. For different scenarios, different debulking devices can reduce the arterial load by removing plaque, thrombus, and hyperplastic intima in the artery. The drug-coated balloon can deliver drugs such as paclitaxel to the target vessel after vessel preparation to inhibit intimal hyperplasia and improve long-term patency rate. In addition to the balloon, the application of stents is particularly important for the endovascular treatment of diabetic lower limb ischemia. However, no stents have been approved for the application of subpatellar vessels in China. In addition to surgical treatment, autologous bone marrow stem cell transplantation, gene therapy and other angiogenesis therapies for diabetic lower limb ischemia are also being explored.