REVIEWS  CRITICAL LIMB ISCHEMIA AND DIABETIC FOOT: AN UPDATE 

The Journal of Cardiovascular Surgery 2013 December;54(6):755-62

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

The diabetic foot: a review

Ricco J. B. ¹, Thanh Phong L. ², Schneider F. ¹, Illuminati G. ³, Belmonte R. ¹, Valagier A. ¹, Régnault De La Mothe G. ¹ ✉

¹ Vascular Surgery Department, Jean Bernard Hospital University of Poitiers, Poitiers, France; ² Vascular Surgery Unit University Medical Center of Hochiminh City Hochiminh City, Vietnam; ³ The “Francesco Durante” Department of Surgery “La Sapienza” University, Rome, Italy

Diabetic foot ulceration (DFU) is among the most frequent complications of diabetes. Neuropathy and ischaemia are the initiating factors and infection is mostly a consequence. We have shown in this review that any DFU should be considered to have vascular impairment. DFU will generally heal if the toe pressure is >55 mmHg and a transcutaneous oxygen pressure (TcPO2) <30 mmHg has been considered to predict that a diabetic ulcer may not heal. The decision to intervene is complex and made according to the symptoms and clinical findings. If both an endovascular and a bypass procedure are possible with an equal outcome to be expected, endovascular treatments should be preferred. Primary and secondary mid-term patency rates are better after bypass, but there is no difference in limb salvage. Bedridden patients with poor life expectancy and a non-revascularisable leg are indications for performing a major amputation. A deep infection is the immediate cause of amputation in 25% to 50% of diabetic patients. Patients with uncontrolled abscess, bone or joint involvement, gangrene, or necrotising fasciitis have a “foot-at risk” and need prompt surgical intervention with debridement and revascularisation. As demonstrated in this review, foot ulcer in diabetic is associated with high mortality and morbidity. Early referral, non-invasive vascular testing, imaging and intervention are crucial to improve DFU healing and to prevent amputation. Diabetics are eight to twenty-four times more likely than non-diabetics to have a lower limb amputation and it has been suggested that a large part of those amputations could be avoided by an early diagnosis and a multidisciplinary approach.