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Diabetic Foot

Lepantalo, M.; Apelqvist, Jan LU ; Setacci, C.; Ricco, J. -B.; de Donato, G.; Becker, F.; Robert-Ebadi, H.; Cao, P.; Eckstein, H. H. and De Rango, P., et al. (2011) In European Journal of Vascular and Endovascular Surgery 42(Suppl. 2). p.60-74
Abstract
Ulcerated diabetic foot is a complex problem. Ischaemia, neuropathy and infection are the three pathological components that lead to diabetic foot complications, and they frequently occur together as an aetiologic triad. Neuropathy and ischaemia are the initiating factors, most often together as neuroischaemia, whereas infection is mostly a consequence. The role of peripheral arterial disease in diabetic foot has long been underestimated as typical ischaemic symptoms are less frequent in diabetics with ischaemia than in non-diabetics. Furthermore, the healing of a neuroischaemic ulcer is hampered by microvascular dysfunction. Therefore, the threshold for revascularising neuroischaemic ulcers should be lower than that for purely ischaemic... (More)
Ulcerated diabetic foot is a complex problem. Ischaemia, neuropathy and infection are the three pathological components that lead to diabetic foot complications, and they frequently occur together as an aetiologic triad. Neuropathy and ischaemia are the initiating factors, most often together as neuroischaemia, whereas infection is mostly a consequence. The role of peripheral arterial disease in diabetic foot has long been underestimated as typical ischaemic symptoms are less frequent in diabetics with ischaemia than in non-diabetics. Furthermore, the healing of a neuroischaemic ulcer is hampered by microvascular dysfunction. Therefore, the threshold for revascularising neuroischaemic ulcers should be lower than that for purely ischaemic ulcers. Previous guidelines have largely ignored these specific demands related to ulcerated neuroischaemic diabetic feet. Any diabetic foot ulcer should always be considered to have vascular impairment unless otherwise proven. Early referral, non-invasive vascular testing, imaging and intervention are crucial to improve diabetic foot ulcer healing and to prevent amputation. Timing is essential, as the window of opportunity to heal the ulcer and save the leg is easily missed. This chapter underlines the paucity of data on the best way to diagnose and treat these diabetic patients. Most of the studies dealing with neuroischaemic diabetic feet are not comparable in terms of patient populations, interventions or outcome. Therefore, there is an urgent need for a paradigm shift in diabetic foot care; that is, a new approach and classification of diabetics with vascular impairment in regard to clinical practice and research. A multidisciplinary approach needs to implemented systematically with a vascular surgeon as an integrated member. New strategies must be developed and implemented for diabetic foot patients with vascular impairment, to improve healing, to speed up healing rate and to avoid amputation, irrespective of the intervention technology chosen. Focused studies on the value of predictive tests, new treatment modalities as well as selective and targeted strategies are needed. As specific data on ulcerated neuroischaemic diabetic feet are scarce, recommendations are often of low grade. (C) 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved. (Less)
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published
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keywords
Diabetic foot, Ischaemia, Neuroischaemia, Vascular impairment, Ulcer, healing, Revascularisation
in
European Journal of Vascular and Endovascular Surgery
volume
42
issue
Suppl. 2
pages
60 - 74
publisher
Elsevier
external identifiers
  • wos:000298517700006
  • scopus:83455187107
ISSN
1532-2165
DOI
10.1016/S1078-5884(11)60012-9
language
English
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yes
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fe474568-3662-4f0c-8359-2e6d77e80c41 (old id 2348458)
date added to LUP
2012-03-01 11:21:01
date last changed
2017-11-05 04:17:47
@article{fe474568-3662-4f0c-8359-2e6d77e80c41,
  abstract     = {Ulcerated diabetic foot is a complex problem. Ischaemia, neuropathy and infection are the three pathological components that lead to diabetic foot complications, and they frequently occur together as an aetiologic triad. Neuropathy and ischaemia are the initiating factors, most often together as neuroischaemia, whereas infection is mostly a consequence. The role of peripheral arterial disease in diabetic foot has long been underestimated as typical ischaemic symptoms are less frequent in diabetics with ischaemia than in non-diabetics. Furthermore, the healing of a neuroischaemic ulcer is hampered by microvascular dysfunction. Therefore, the threshold for revascularising neuroischaemic ulcers should be lower than that for purely ischaemic ulcers. Previous guidelines have largely ignored these specific demands related to ulcerated neuroischaemic diabetic feet. Any diabetic foot ulcer should always be considered to have vascular impairment unless otherwise proven. Early referral, non-invasive vascular testing, imaging and intervention are crucial to improve diabetic foot ulcer healing and to prevent amputation. Timing is essential, as the window of opportunity to heal the ulcer and save the leg is easily missed. This chapter underlines the paucity of data on the best way to diagnose and treat these diabetic patients. Most of the studies dealing with neuroischaemic diabetic feet are not comparable in terms of patient populations, interventions or outcome. Therefore, there is an urgent need for a paradigm shift in diabetic foot care; that is, a new approach and classification of diabetics with vascular impairment in regard to clinical practice and research. A multidisciplinary approach needs to implemented systematically with a vascular surgeon as an integrated member. New strategies must be developed and implemented for diabetic foot patients with vascular impairment, to improve healing, to speed up healing rate and to avoid amputation, irrespective of the intervention technology chosen. Focused studies on the value of predictive tests, new treatment modalities as well as selective and targeted strategies are needed. As specific data on ulcerated neuroischaemic diabetic feet are scarce, recommendations are often of low grade. (C) 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.},
  author       = {Lepantalo, M. and Apelqvist, Jan and Setacci, C. and Ricco, J. -B. and de Donato, G. and Becker, F. and Robert-Ebadi, H. and Cao, P. and Eckstein, H. H. and De Rango, P. and Diehm, N. and Schmidli, J. and Teraa, M. and Moll, F. L. and Dick, F. and Davies, A. H.},
  issn         = {1532-2165},
  keyword      = {Diabetic foot,Ischaemia,Neuroischaemia,Vascular impairment,Ulcer,healing,Revascularisation},
  language     = {eng},
  number       = {Suppl. 2},
  pages        = {60--74},
  publisher    = {Elsevier},
  series       = {European Journal of Vascular and Endovascular Surgery},
  title        = {Diabetic Foot},
  url          = {http://dx.doi.org/10.1016/S1078-5884(11)60012-9},
  volume       = {42},
  year         = {2011},
}