Treatment of Vasculopathy in Diabetic Foot by Percutaneous Transluminal Angioplasty

경피적 동맥확장술을 이용한 당뇨족 허혈의 치료

  • Kim, Hong-Ryul (Department of Plastic Surgery and Diabetic Wound Center, Korea University College of Medicine) ;
  • Han, Seung-Kyu (Department of Plastic Surgery and Diabetic Wound Center, Korea University College of Medicine) ;
  • Rha, Seung-Woon (Department of Plastic Surgery and Diabetic Wound Center, Korea University College of Medicine) ;
  • Kim, Hyon-Surk (Department of Plastic Surgery and Diabetic Wound Center, Korea University College of Medicine) ;
  • Kim, Woo-Kyung (Department of Plastic Surgery and Diabetic Wound Center, Korea University College of Medicine)
  • 김홍렬 (고려대학교 의과대학 성형외과학교실, 당뇨성 창상센터) ;
  • 한승규 (고려대학교 의과대학 성형외과학교실, 당뇨성 창상센터) ;
  • 나승운 (고려대학교 의과대학 성형외과학교실, 당뇨성 창상센터) ;
  • 김현석 (고려대학교 의과대학 성형외과학교실, 당뇨성 창상센터) ;
  • 김우경 (고려대학교 의과대학 성형외과학교실, 당뇨성 창상센터)
  • Received : 2009.07.07
  • Accepted : 2010.01.11
  • Published : 2010.03.10

Abstract

Purpose: In treating diabetic foot ulcers, satisfactory vascularity is an essential prerequisite. To improve vascularity, a bypass graft has long been carried out. Recently, however, percutaneous transluminal angioplasty (PTA) has also been tried since the PTA is less invasive than the bypass graft. However, publication demonstrating the improvement of vascularity after the PTA are lacking. Therefore, this study was designed to show usefulness of the PTA in treating vasculopathy of diabetic foot. Materials: and Methods This study included 30 feet of 24 ischemic diabetic foot patients. Inclusion criteria were diabetes (duration > 5 years) and a significant lower extremity ischemia, as determined by a transcutaneous oxygen pressure ($TcpO_2$) < 30 mmHg. The PTA was carried out in 61 arteries. PTA procedure was considered successful, when residual stenosis was less than 30%. The procedure was considered failed when residual stenosis was more than 50%. Residual stenosis between 30% and 50% was considered acceptable. For evaluation of PTA effect, foot $TcpO_2$ and infrared thermography were measured before and 7th day after PTA. Results: Immediately after PTA performed in 61 arteries, 58 and 3 arteries were evaluated as being successful and acceptable, respectively. Before PTA, average foot $TcpO_2$ was $12.6{\pm}8.8$ mmHg and its value was increased to $44.2{\pm}23.9$ on 7th day after PTA (p<0.01). Average skin temperature was $31.8{\pm}1.2^{\circ}C$ before PTA and it was increased to $33.5{\pm}1.1^{\circ}C$ on 7th day after PTA (p<0.01). Conclusion: PTA procedure increases tissue oxygenation of ischemic diabetic feet which do not have wound healing potential due to low tissue oxygenation, to the level of possible wound healing. In addition, PTA increases skin temperature of ischemic diabetic feet which can imply an improvement of peripheral circulation.

Keywords

References

  1. Jude EB, Unsworth PF: Optimal treatment of infected diabetic foot ulcers. Drugs Aging 21: 833, 2004 https://doi.org/10.2165/00002512-200421130-00002
  2. Pomposelli FB, Kansal N, Hamdan AD, Belfield A, Sheahan M, Campbell DR, Skillman JJ, Logerfo FW: A decade of experience with dorsalis pedis artery bypass: Analysis of outcome in more than 1000 cases. J Vasc Surg 37: 307, 2003 https://doi.org/10.1067/mva.2003.125
  3. Jacqueminet S, Hartemann-Heurtier A, Izzillo R, Cluzel P, Golmard JL, Ha Van G, Koskas F, Grimaldi A: Percutaneous transluminal angioplasty in severe diabetic foot ischemia: Outcomes and prognostic factors. Diabetes Metab 31: 370, 2005 https://doi.org/10.1016/S1262-3636(07)70206-9
  4. Nasr MK, McCarthy RJ, Hardman J, Chalmers A, Horrocks M: The increasing role of percutaneous transluminal angioplasty in the primary management of critical limb ischaemia. Eur J Vasc Endovasc Surg 23: 398, 2002 https://doi.org/10.1053/ejvs.2002.1615
  5. Wolfle KD, Bruijnen H, Reeps C, Reutemann S, Wack C, Campbell P, Loeprecht H, Hauser H, Bohndorf K: Tibioperoneal arterial lesions and critical foot ischaemia: successful management by the use of short vein grafts and percutaneous transluminal angioplasty. Vasa 29: 207, 2000 https://doi.org/10.1024/0301-1526.29.3.207
  6. Capek P, McLean GK, Berkowitz HD: Femoropopliteal angioplasty. factors influencing long-term success. Circulation 83 (2 Suppl): I70, 1991 https://doi.org/10.1161/01.CIR.83.1.70
  7. Dawson DL, Mills JL: Critical limb ischemia. Curr Treat Options Cardiovasc Med 9: 159, 2007 https://doi.org/10.1007/s11936-007-0009-2
  8. Kudo T, Chandra FA, Kwun WH, Haas BT, Ahn SS: Changing pattern of surgical revascularization for critical limb ischemia over 12 years: endovascular vs. open bypass surgery. J Vasc Surg 44: 304, 2006 https://doi.org/10.1016/j.jvs.2006.03.040
  9. Mayrovitz HN, Larson PB: Functional microcirculatory impairment: A possible source of reduced skin oxygen tension in human diabetes mellitus. Microvasc Res 52: 115, 1996 https://doi.org/10.1006/mvre.1996.0048
  10. Byrne P, Provan JL, Ameli FM, Jones DP: The use of transcutaneous oxygen tension, measurements in the diagnosis of peripheral vascular insufficiency. Ann Surg 200: 159, 1984 https://doi.org/10.1097/00000658-198408000-00007
  11. Cina C, Katsamouris A, Megerman J, Brewster DC, Strayhorn EC, Robison JG, Abbott WM: Utility of transcutaneous oxygen tension measurements in peripheral arterial occlusive disease. J Vasc Surg 1: 362, 1984 https://doi.org/10.1016/0741-5214(84)90069-7
  12. Bharara M, Cobb JE, Claremont DJ: Thermography and thermometry in the assessment of diabetic neuropathic foot: A case of furthering the role of thermal techniques. Int J Low Extrem Wounds 5: 250, 2006 https://doi.org/10.1177/1534734606293481
  13. Yambe T, Inoue A, Sekine K, Shiraishi Y, Watanabe M, Yamaguchi T, Shibata M, Maruyama M, Konno S, Nitta S: Effect of the alternative magnetic stimulation on peripheral circulation for regenerative medicine. Biomed Pharmacother 59: 174, 2005 https://doi.org/10.1016/S0753-3322(05)80027-7
  14. Sun PC, Jao SH, Cheng CK: Assessing foot temperature using infrared thermography. Foot Ankle Int 26: 847, 2005 https://doi.org/10.1177/107110070502601010
  15. Ballard JL, Eke CC, Bunt TJ, Killeen JD: A prospective evaluation of transcutaneous oxygen measurements in the management of diabetic foot problems. J Vasc Surg 22: 485, 1995 https://doi.org/10.1016/S0741-5214(95)70018-8