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Courtois MC, Sapoval M, Del Giudice C, Ducloux R, Mirault T, Messas E. [Distal revascularization in diabetic patients with chronic limb ischemia]. ACTA ACUST UNITED AC 2015; 40:24-36. [PMID: 25596672 DOI: 10.1016/j.jmv.2014.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 12/04/2014] [Indexed: 12/01/2022]
Abstract
Diabetes mellitus is an independent risk factor for peripheral artery disease. Life expectancy is 41 months for diabetic patients with an ischemic ulcer. The characteristics of diabetic arteriopathy make its treatment more difficult than in non-diabetic patients. Few data are available about the surgical treatment of arteriopathy in diabetic patients (including angioplasty or bypass), especially in case of distal arteriopathy. The choice of the procedure depends on multiple factors such as the disease localization, its extent, distal blood flow and vascular disease-related surgical risk. The principal aim of revascularisation is to restore direct flow to the foot in order to ensure wound healing and limb salvage. With percutaneous endoluminal angioplasty, limb salvage can be achieved in more than 80% of patients at 1-3 years. The percutaneous procedure is less invasive than open surgery, there are fewer complications, and morbidity and mortality rates are reduced; moreover, a second procedure remains possible in the future. With bypass surgery, the rate of limb salvage exceeds 80% at five years. Nevertheless, peri-operative mortality reaches 3% and arterial anatomy, patient-related risks factors or venous graft availability may be limitations. New endovascular techniques especially designed for the distal arteries of the lower limbs enable very distal revascularization with morbidity and mortality rates lower than with surgery.
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Affiliation(s)
- M-C Courtois
- Unité de médecine vasculaire, service de médecine vasculaire, université Paris-Descartes, hôpital européen George-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - M Sapoval
- Service de radiologie interventionnelle vasculaire et oncologique, université Paris-Descartes, hôpital européen George-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - C Del Giudice
- Service de radiologie interventionnelle vasculaire et oncologique, université Paris-Descartes, hôpital européen George-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - R Ducloux
- Service de diabétologie, université Paris-Descartes, hôpital européen George-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - T Mirault
- Service de réadaptation vasculaire, université Paris-Descartes, hôpital Corentin-Celton, 4, parvis Corentin-Celton, 92130 Issy-les-Moulineaux, France
| | - E Messas
- Unité de médecine vasculaire, service de médecine vasculaire, université Paris-Descartes, hôpital européen George-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
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Endovascular revascularization and free tissue transfer for lower limb salvage. J Plast Reconstr Aesthet Surg 2014; 67:1407-14. [DOI: 10.1016/j.bjps.2014.05.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 05/15/2014] [Indexed: 11/21/2022]
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