Algorithm of Medical-Surgical Treatment in the Peripheral Arterial Disease of the Diabetic Patient.

Introduction: We live in a society with a growing number of diabetics. That is why the number of diabetic patients with peripheral arterial disease is expanding, as is the number of cases of chronic ischemia, which threatens limb viability, or chronic limb-threatening ischemia (CLTI). The appearance of diabetic foot ulcers with an ischemic component represents the maximum risk of amputation in the absence of a firm and rapid revascularization intervention. In our study, we aim at early detection of patients who need infusion treatment immediately after surgical revascularization. Materials and methods: This is a six-year retrospective study of 115 patients with infrainguinal occlusive disease and CLTI. All subjects were classified according to the WIfI system before and after revascularization. We made a score based on the postoperative clinical evolution in the first three days in order to have an objective image of patients who received infusion treatment with PG E1. Results: All patients included in our study had diabetes. They were divided into two groups, one comprising 86 patients who underwent exclusively surgical treatment, and the other comprising 29 patients, who received a combined surgical and medical treatment. We showed that subjects who had a low postoperative score and received infusion treatment had a higher rate of limb rescue in the first year. Conclusions: In diabetic patients with infrainguinal occlusive disease who were treated in the Clinic, without the possibility of endovascular or hybrid interventions, the combination of infusion treatment with PG E1 after surgical revascularization led to a higher rate of limb rescue and healing of ischemic trophic lesions after one year.

Surgical Revascularization in Chronic Limb-threatening Ischemia in Diabetic Patients.

Introduction: Diabetes mellitus is one of the chronic diseases that showed a steady increase in the number of patients in the last decades. After the diagnosis of diabetes mellitus, evolution towards limb amputation goes, step by step, through neuropathy, leg ulcers and infection appearance. The existence of diabetic arteriopathy prevents ulcer's healing due to the limb's ischemic status. By restoring arterial flow in the lower extremity, we solve the most important cause for diabetic foot ulcers, namely ischemia. Material and Methods: In the Surgery Clinic of Dr I Cantacuzino Clinical Hospital, Surgical Repair of Diabetic Foot Compartment, the first revascularizations were made approx 5 years ago. During this time we have made constant efforts to lower the number of major amputations by diversifying the interventions dedicated almost exclusively to patients with ulcer of the diabetic foot. Results: The number of major amputations is lower after revascularisation and we have obtained complete ulcer's healing and a functional extremity. We have 80 patients in observation who underwent revasculariosation surgery, ages between 40 and 75 years, 46 men and 34 women. All of them were diabetic patients with critical ischemia and various associated comorbidities: 24% arterial hypertension, 14% polineuropathy, 12% dyslipidemia. The complications occured in the first year of follow-up were 14 cases of graft thrombosis and only 6 cases of major amputation. Conclusions: Before tempting any type of amputation, major or minor, after local infection control by treatment, debridement or dressings, and after vascular evaluation, it is essential to restore arterial flow.