Associations Between Systolic Pressure, Vascular Waveform, and Volume Flow with Debridement or Amputation Treatment Decisions in Diabetic Foot Ulcer Patients.

INTRODUCTION: Diabetic foot ulcer disease, affecting 6.3% of the global population, necessitates crucial decisions regarding debridement and amputation, with substantial cost, morbidity, and mortality implications. This study's primary goal is to determine effective vascular examination modalities, including systolic blood pressure, vascular waveforms, and blood volume flow to guide optimal treatments for diabetic foot patients. METHOD: This cross-sectional study at Cipto Mangunkusumo General Hospital aimed to identify effective vascular examination modalities, such as systolic blood pressure, vascular waveforms, and blood volume flow, to guide treatment choices for diabetic foot patients. The study included 38 subjects, equally split between debridement and amputation groups. RESULTS: Notably, the presence of a biphasic pattern in popliteal artery vascular examinations was associated with the decision for amputation in diabetic foot patients (p < 0.05). The Chi-square test revealed that a biphasic ultrasound pattern served as a predictive factor for amputation among diabetic foot patients, with three times more biphasic patients choosing amputation over debridement. Conversely, assessments of popliteal artery systolic pressure, common femoral artery waveform, popliteal artery volume flow, and common femoral artery volume flow showed no significant correlations with the choice of debridement or amputation treatment for diabetic foot patients. CONCLUSION: In summary, ultrasound assessment of vascular waveform in the popliteal artery emerges as a predictive factor for amputation or debridement in diabetic foot patients.

Healing rate comparison of revascularized and non-revascularized diabetic foot ulcers with peripheral arterial disease.

Background: Revascularization is important for the healing of diabetic foot ulcers with peripheral arterial disease because it aids in the restoration of the perfusion function of the leg tissues and can reduce the risk of cardiovascular complications. However, no Indonesian studies have been identified that exclusively discuss the effectiveness of revascularization for patients with this condition. This study aimed to compare the healing rates of diabetic foot ulcers with peripheral arterial disease in patients who received or did not receive revascularization. Methods: This cohort study included diabetic foot ulcer patients with peripheral arterial disease undergoing treatment at our institution who received or did not receive revascularization based on the wound, ischemia, and foot infection (WIfI) score criteria. Wound healing was considered complete re-epithelialization within six months of the procedure or consistent epithelialization for four consecutive weeks. Patients who required amputation within six months of observation were deemed to have failed therapy. Results: Each group contained 23 patients. The revascularization group exhibited a healing rate of 78.3 % (18 patients), while the non-revascularization patients had a rate of 26.1 % (6 patients). The wounds of revascularized patients were 14.944 (1.102-202.692) times more likely to heal than those without revascularization (p < 0.01). WIfI stage 2-3 patients showed an 11.926 (1.438-98.883) times increase in the likelihood of wound healing compared to stage 4 WIfI patients. Conclusion: The wound healing rate was higher for revascularized patients than for non-revascularized patients, and the severity of the wound based on WIfI score affected patient wound healing.

Risk Factors of Asymptomatic Carotid Artery Disease in Geriatric Evaluated Using Carotid Intima-Media Thickness (IMT) Measurement, the First Indonesian Population Study.

Carotid artery disease in geriatric is one of the important etiologies of stroke, which topped the cause of mortality in Indonesia. Specific prevention should be done as early as asymptomatic disease occurred. Initial assessment can be performed using ultrasound by measuring the intima-media thickness (IMT) of carotid artery, which can evaluate earlier progression of the atherosclerosis process. Unfortunately, we do not have risk factors categorization that show us which geriatric population fall under high-risk stratification to be screened. Study was done to Indonesian geriatric population. Asymptomatic carotid disease was tested positive if IMT was > 0.9 mm without any previous neurological symptoms. Correlation of the result was statistically tested with risk factors of atherosclerotic process, such as sex, body mass index, presence of hypertension, diabetes mellitus, and hypercholesterolemia. Study obtained 104 subjects and showed the prevalence of asymptomatic carotid disease was 37.5%. Two risk factors: diabetes mellitus and hypercholesterolemia were statistically significant ( p = 0.01) with odds ratio (OR) 3.56 (1.31-9.64, 95% confidence interval [CI]) and OR 2.85 (1.25-6.51, CI 95%), respectively. Logistic regression showed the risk was 69.2% by having two of these comorbidities, 47.2 or 42.5% if diabetes mellitus or hypercholesterolemia was present. As diabetes mellitus and hypercholesterolemia were proved to be significant risk factors for asymptomatic carotid artery disease, we recommend performing ultrasound screening to measure carotid artery IMT for geriatric population who had diabetes mellitus and/or hypercholesterolemia for asymptomatic carotid artery disease to be diagnosed and further treated.

The Correlation of Short-Chain Fatty Acids with Peripheral Arterial Disease in Diabetes Mellitus Patients.

Diabetes mellitus (DM) is a significant risk factor for peripheral arterial disease (PAD). PAD affects 20% of DM patients over 40 and has increased by 29% in the last 50 years. The gut microbiota produces short-chain fatty acids (SCFAs) that affect atherosclerosis. SCFA inhibits inflammation, which contributes to atherosclerosis. This study tried to link feces SCFA levels to atherosclerosis in people with diabetes with peripheral arterial disease (PAD). The study included 53 people with diabetes and PAD: gas chromatography-mass spectrometry measured acetate, butyrate, and propionate levels in feces samples (GC-MS). There was a positive correlation between random blood glucose (RBG) levels, peak systolic velocity (PSV), volume flow (VF), plaque, relative and absolute acetate, relative valerate, butyrate, and propionate. This supports the idea that elevated SCFA levels in type 2 diabetic (T2D) patients reduce adipose tissue inflammation and cholesterol metabolism, contributing to atherosclerosis pathogenesis. We conclude that increased fecal SCFA excretion is linked to cardiovascular disease. To determine the causal effect correlation of the SCFA with clinical and laboratory parameters for PAD in DM patients, compare the SCFA in plasma and feces, and account for confounding variables, a specific method with larger sample sizes and more extended follow-up periods is required.

A systematic review of the current status of interventions for type II endoleak after EVAR for abdominal aortic aneurysms.

OBJECTIVE: To study the mid- and long-term outcomes of type II endoleak treatment after EVAR and the technical aspects of different techniques to exclude endoleaks which different embolic agents. METHODS: A systematic review was performed using the approach recommended by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for meta-analyses of interventional studies. The comprehensive search was conducted using the following database: MEDLINE, EMBASE, and the Cochrane Library. Patient characteristic, intervention approaches, embolic agents, and results at mid and long term follow up were studied. RESULTS: A total of 6 studies corresponding to a total of 141 patients fulfilled the inclusion criteria with a mean age of 73-78.6 years and a mean duration of follow up varying from 25 to 42 months. There were different techniques for embolization used (translumbar, transarterial, and transcaval approach) with various types of embolic agents. In all studies, the indication for embolization of the type II endoleaks was sac enlargement of more than 5 mm. A wide range of technical success rate was reported regardless of the intervention strategy being used (17,6%-100%). The overall technical success rate of all studies was 62%. CONCLUSION: This systematic review shows that there is a wide variety of techniques to exclude a persistent type II endoleak. Different kinds of embolic agents have be used. Due to a lack of peer reviewed data on longterm follow-up, it was not possible to come to recommendations what treatment would be the best for a durable exclusion of a persistent type II endoleak after an initially successful EVAR. There remains an urgent need for proper executed studies, either randomized or with close observation in relation to longer follow-up.

Effectiveness of Doppler Ultrasonography as a Predictor of Wound Healing after Below-Knee Amputation for Peripheral Arterial Disease.

Background: tool is needed to predict how wound following below-knee amputation (BKA) surgery will heal in patient with peripheral artery disease (PAD). Ultrasonography is an alternative to evaluate the condition of the arteries. We conducted a study to investigate the association between doppler ultrasonography as pre-amputation assessment with primary wound healing following BKA surgery. Methods: A case-control study was conducted to investigate the effectiveness of ultrasonography as a predictor of the wound healing. Bivariate and multivariate analysis were performed to explore association between ultrasonography indicators including peak systolic velocity, volume flow, arterial diameter, and distal artery spectral waveform with wound healing following BKA. Ultrasonography assessments were conducted on the popliteal artery, anterior tibial artery, and posterior tibial artery. Results: Based on the multivariate analysis on all arteries, there were statistically significant associations of peak systolic velocity (adjusted odd ratio [OR]= 5.584, 95% confidence interval [CI]= 1.291 24.157, p= 0.021), volume flow (adjusted OR= 4.760, 95% CI= 1.200 18.876, p= 0.026), and arterial diameter (adjusted OR= 6.507, 95% CI= 1.510 - 28.033, p= 0.012) with wound healing after BKA. Conclusions: Doppler ultrasonography of PAD can be used as a predictive pre-amputation testing modality to predict wound healing after BKA.