title: [Distal revascularization in diabetic patients with chronic limb ischemia].
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.
authors.affiliation: Unité de médecine vasculaire, service de médecine vasculaire, université Paris-Descartes, hôpital européen George-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
authors.forename: M-C
authors.initials: MC
authors.lastname: Courtois
authors.affiliation: Service de radiologie interventionnelle vasculaire et oncologique, université Paris-Descartes, hôpital européen George-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Sapoval
authors.affiliation: Service de radiologie interventionnelle vasculaire et oncologique, université Paris-Descartes, hôpital européen George-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Del Giudice
authors.affiliation: Service de diabétologie, université Paris-Descartes, hôpital européen George-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Ducloux
authors.affiliation: Service de réadaptation vasculaire, université Paris-Descartes, hôpital Corentin-Celton, 4, parvis Corentin-Celton, 92130 Issy-les-Moulineaux, France.
authors.forename: T
authors.initials: T
authors.lastname: Mirault
authors.affiliation: Unité de médecine vasculaire, service de médecine vasculaire, université Paris-Descartes, hôpital européen George-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France. Electronic address: emmanuel.messas@egp.aphp.fr.
authors.forename: E
authors.initials: E
authors.lastname: Messas
mesh_terms: D001783:Blood Flow Velocity; D003925:Diabetic Angiopathies / Q000601:surgery*; D057510:Endovascular Procedures; D006801:Humans; D007511:Ischemia / Q000601:surgery; D023821:Limb Salvage / Q000379:methods*; D035002:Lower Extremity / Q000098:blood supply*; D058729:Peripheral Arterial Disease / Q000150:complications / Q000601:surgery*; D012307:Risk Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality
keywords: Angioplastie percutanée; Artériopathie périphérique; Bypass; Diabetes mellitus; Diabète; Percutaneous angioplasty; Peripheral arterial disease; Pontage artériel