TOTBİD Dergisi

TOTBİD Dergisi

2015, Cilt 14, Sayı, 5     (Sayfalar: 387-391)

Vascular problems in diabetic foot

Selçuk Baktıroğlu 1, Fatih Yanar 1, İbrahim H. Özata 1

1 İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, İstanbul

DOI: 10.14292/totbid.dergisi.2015.57
Görüntüleme: 162
İndirme : 131

Almost 50% of the patients with diabetic foot ulcers also have peripheral arterial disease (PAD). PAD is an important risk factor for the failure of wound healing and lower limb amputations. Peripheral arterial disease causing arterial insufficiency is an important predictor of the outcome of ulceration of the foot in patients with diabetes. Atherosclerosis, begins earlier, is more aggressive, and multisegmentary in nature in diabetic patients. Especially the trifurcation arteries distal to the popliteal artery are usually affected. Arteries distal to the ankle are not affected differently in diabetics. PAD - Atherosclerosis is mostly seen in the lower extremities and the first complaint is usually pain. Pain is in the form of claudicatio intermittens in the beginning and usually seen in the calf muscles. With the progression of the disease, rest pain in the distal parts of the foot is seen and during the night the patient has to keep his leg in a dependent position. Usually a revascularisation is needed in these patients. Ulcers and gangrene may be seen in the more progressive forms of arterial stenoses/ occlusions. Clinical examination is the most useful diagnostic method. Diagnosis can easily be made by a careful history taking, inspection, and palpation of the pulses. Pressure recordings done by hand held Doppler device is usually helpful, and should be performed whenever possible. Color Doppler examination can provide more anatomical and functional information. Digital subtraction angiography (DSA) is needed if ischemia is serious/ critical or the wound cannot be healed in 6 weeks with close monitoring and aggressive wound care. DSA is the gold standard. MR and CT angiographic examinations are other useful techniques, not as useful as DSA. During DSA, angioplasty and stenting can also be accomplished during the same procedure. Endarterectomy and by-pass are the surgical techniques that may be used. Surgical and radiologic techniques can be used in the same patient, and the decision should be made on an individual basis on every patient.

Anahtar Kelimeler : diabetic foot; peripheral arterial disease (PAD)