Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.
You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!
If you have any problems with the registration process or your account login, please contact contact us.
Improving limb salvage rate in diabetic patients with critical leg ischaemia using a multidisciplinary approach.
Zayed H, Halawa M, Maillardet L, Sidhu P, Edmonds M, Rashid H. Int J Clin Pract. 2008 Feb 1 [Epub ahead of print]
Quote:
Background: Diabetic patients are more likely to develop critical leg ischaemia (CLI) and subsequently major amputation than the general population. Major amputation rate in this group is reported to be high compared with non-diabetic patients with a devastating outcome.
Aim: The aim of this study was to assess the impact of a multidisciplinary approach on the major amputation rate in diabetic patients with CLI suitable for surgical or radiological revascularisation.
Methods: A retrospective analysis of data of all diabetic patients with CLI presenting to a one-stop multidisciplinary clinic between December 2003 and May 2006 was performed. The multidisciplinary team included a vascular surgeon, diabetologist, podiatrist, tissue viability nurse, interventional radiologist and a radiology coordinator. Peripheral vascular disease was assessed by history taking, clinical examination, ankle brachial pressure index, Doppler arterial waveform analysis and transcutaneous oxygen tension. Duplex scan and magnetic resonance angiography were performed in selected patients. Based on the available information, suitable patients were offered percutaneous transluminal angioplasty (PTA), surgical arterial reconstruction (SAR) or both (hybrid arterial reconstruction).
Results: Three hundred and twelve diabetic patients with CLI were suitable for revascularisation. Eighty-two per cent underwent PTA while 18% underwent SAR. Thirteen threatened grafts were detected during follow-up and early intervention was performed as required. Major amputation rate among the study group was 4.1%.
Conclusion: Multidisciplinary approach improves the care of diabetic patients with CLI. Close follow-up and early intervention in dedicated centres improve limb salvage rates in this group of high-risk patients.
Re: Improving limb salvage rate in diabetic patients with critical leg ischaemia
Intermittent intravenous urokinase for critical limb ischemia in diabetic foot ulceration.
Weck M, Rietzsch H, Lawall H, Pichlmeier U, Bramlage P, Schellong S. Thromb Haemost. 2008 Sep;100(3):475-82.
Quote:
Patients with diabetic foot ulceration and critical limb ischemia have a high risk of major amputation, especially if limbs can not be revascularized. Urokinase is effective in improving microcirculation in critical limb ischemia and might improve outcomes. There are no data on the efficacy and safety of urokinase treatment (survival free of major amputation, ulcer healing and the rate of minor and major bleeding). Therefore, we aimed to investigate the effect of urokinase treatment in a phase II clinical trial. We performed an open, prospective, non-controlled, multicenter phase II cohort study in 77 type-2 diabetic patients with critical limb ischemia and diabetic foot ulceration. Patients had no surgical or endovascular treatment option based on interdisciplinary consensus. Urokinase (1 Mio IU if plasma fibrinogen >/=2.5 g/l, 0.5 Mio IU if fibrinogen <2.5 g/l) was administered for 21 days as an intravenous infusion over 30 minutes. Each patient was followed up for 12 months. Treatment for a median of 21 days resulted in 33% of patients being alive, having no major amputation and completely healed ulcers after 12 months. Total survival rate was 84.6%, amputation-free survival 69.2% and rate of major amputation 21.1%. Eighty-two percent of patients experienced at least once a complete ulcer healing within the course of study. Three serious adverse events were urokinase-related. Urokinase treatment in diabetic patients with critical limb ischemia appears to be effective, feasible and safe. Although this calls for a larger, randomized and controlled trial, the results are highly relevant for clinical practice to prevent these patients from receiving major amputation due to diabetic foot syndrome.
Improving limb salvage rate in diabetic patients with critical leg ischaemia
Linear Mode
