Published on:
    Journal of Cardiovascular Disease Research, 2013; 4(2):79-83
    Review Article | doi:10.1016/j.jcdr.2012.10.002

    Surgical revascularization techniques for diabetic foot

    Authors:

    Siva Krishna Kota a , Sunil Kumar Kota b,* , Lalit Kumar Meher ,c Satyajit Sahoo d, Sudeep Mohapatra e, Kirtikumar Dharmsibhai Modi b

    a Department of Anesthesia, Central Security Hospital, Riyadh, Saudi Arabia

    b Department of Endocrinology, Medwin Hospitals, Chiragh Ali Lane, Nampally, Hyderabad, Andhra Pradesh, India

    c Department of Medicine, MKCG Medical College, Orissa, India

    d Department of Cardio Thoracic Vascular Surgery, BJ Medical College, Pune, Maharashtra, India

    e Department of Anesthesia, Fortis Hospital, Bangalore, Karnataka, India

    Abstract:

    Diabetes is an important risk factor for atherosclerosis. The diabetic foot is characterized by the presence of arteriopathy and neuropathy. The vascular damage includes non-occlusive microangiopathy and macroangiopathy. Diabetic foot wounds are responsible for 5e10% of the cases of major or minor amputations. In fact, the risk of amputation of the lower limbs is 15e20% higher in diabetic populations than in the general population. The University of Texas classification is the reference classification for diabetic wounds. It distinguishes non-ischemic wounds from ischemic wounds which are associated with a higher rate of amputation. The first principles of treatment are the control of pain of an eventual infection. When ischemia is diagnosed, restoration of pulsatile blood flow by revascularization may be considered for salvaging the limb. The treatment options are angioplasty with or without stenting and surgical bypass or hybrid procedures combining the two. Distal reconstructions with anastomosis to the leg or pedal arteries have satisfactory limb-salvage rates. Subintimal angioplasty is a more recent endovascular technique. It could be suggested for elderly patients who are believed to be unsuitable candidates for a conventional bypass or angioplasty. The current article would focus on the various revascularization procedures.

    Key words: Angioplasty, Bypass, Diabetes, Revascularization.