title: Surgical revascularization techniques for diabetic foot.
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 5-10% of the cases of major or minor amputations. In fact, the risk of amputation of the lower limbs is 15-20% 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.
authors.affiliation: Department of Anesthesia, Central Security Hospital, Riyadh, Saudi Arabia.
authors.forename: Siva Krishna
authors.initials: SK
authors.lastname: Kota
authors.forename: Sunil Kumar
authors.initials: SK
authors.lastname: Kota
authors.forename: Lalit Kumar
authors.initials: LK
authors.lastname: Meher
authors.forename: Satyajit
authors.initials: S
authors.lastname: Sahoo
authors.forename: Sudeep
authors.initials: S
authors.lastname: Mohapatra
authors.forename: Kirtikumar Dharmsibhai
authors.initials: KD
authors.lastname: Modi
keywords: Angioplasty; Bypass; Diabetes; Revascularization
references.citation: J Vasc Surg. 2008 Oct;48(4):878-84
references.pmid: 18586445
references.citation: Eur J Vasc Surg. 1994 Mar;8(2):214-9
references.pmid: 8181619
references.citation: J Vasc Surg. 2000 Jan;31(1 Pt 2):S1-S296
references.pmid: 10666287
references.citation: Clin Infect Dis. 2004 Oct 1;39(7):885-910
references.pmid: 15472838
references.citation: Ann Vasc Surg. 1995;9 Suppl:S24-31
references.pmid: 8688306
references.citation: Eur J Vasc Surg. 1994 Mar;8(2):148-55
references.pmid: 8181606
references.citation: J Vasc Surg. 2007 Jan;45 Suppl S:S5-67
references.pmid: 17223489
references.citation: J Cardiovasc Surg (Torino). 2000 Feb;41(1):109-12
references.pmid: 10836234
references.citation: J Endovasc Ther. 2002 Aug;9(4):411-6
references.pmid: 12223000
references.citation: Diabet Med. 1990 Aug;7(7):590-4
references.pmid: 2146065
references.citation: J Vasc Surg. 2008 Jan;47(1):101-8
references.pmid: 18178459
references.citation: BMJ. 2000 Mar 11;320(7236):698-701
references.pmid: 10710584
references.citation: Adv Cardiol. 2007;44:117-124
references.pmid: 17075202
references.citation: J Mal Vasc. 2001 Apr;26(2):122-5
references.pmid: 11319418
references.citation: Diabetologia. 1993 Jul;36(7):615-21
references.pmid: 8359578
references.citation: Ann Vasc Surg. 2008 Mar;22(2):195-9
references.pmid: 18346571
references.citation: J Foot Ankle Surg. 1996 Nov-Dec;35(6):528-31
references.pmid: 8986890
references.citation: Lancet. 2003 May 3;361(9368):1545-51
references.pmid: 12737879
references.citation: Diabet Med. 2001 Jul;18(7):528-32
references.pmid: 11553180
references.citation: Diabetes Care. 2005 Sep;28(9):2206-10
references.pmid: 16123491
references.citation: J Mal Vasc. 2002 Dec;27(5):280; discussion 284-6
references.pmid: 12525778
references.citation: Cardiovasc Intervent Radiol. 2008 Jul-Aug;31(4):687-97
references.pmid: 18414946
references.citation: Clin Podiatr Med Surg. 2003 Oct;20(4):689-708
references.pmid: 14636033
references.citation: J Vasc Surg. 2007 Feb;45(2):304-10; discussion 310-1
references.pmid: 17264008
references.citation: Arch Surg. 2000 Apr;135(4):452-6
references.pmid: 10768711
references.citation: Diabetes Care. 2003 Dec;26(12):3333-41
references.pmid: 14633825
references.citation: Presse Med. 2011 Jan;40(1 Pt 1):10-6
references.pmid: 20980123
references.citation: Med Mal Infect. 2007 Jan;37(1):1-25
references.pmid: 17357221
references.citation: Eur J Vasc Endovasc Surg. 2010 Oct;40(4):515-20
references.pmid: 20619700
references.citation: Diabetes Care. 1995 Feb;18(2):216-9
references.pmid: 7729300
references.citation: Circulation. 1991 Feb;83(2 Suppl):I20-7
references.pmid: 1899367
references.citation: Eur J Vasc Endovasc Surg. 2009 Apr;37(4):448-56
references.pmid: 19213580