Pedal bypass in the treatment of arterial occlusive disease of the lower extremities in diabetics
Petrasovic, M.; Belacek, J.; Holoman, M.
Bratislavske Lekarske Listy 100(6): 312-316
1999
ISSN/ISBN: 0006-9248 PMID: 10573646 Document Number: 506849
The increase of the number of diabetics in the population and prolongation of their survival increases also the number of patients suffering from diabetic foot syndrome. Terminal complication of diabetic foot syndrome is diabetic gangrene, which is the cause of 50% of major amputations performed in Slovak republic. The problem of major amputations is not only medical, but also economic one. Adequate treatment can reduce the number of amputations by 50%. One of the possibilities to improve the prognosis of a diabetic suffering from obliterative macroangiopathy is the treatment by distal bypass, because with the regard to the characteristic distribution of the lesions to leg arteries is the classic vessel surgery (aortofemoral and femoropopliteal/femorocrural bypasses) inefficient. After the introduction of this treatment at our department preliminary results and some prognostic factors of the surgery success were evaluated. To evaluate the efficiency of pedal bypass as a method of treatment for peripheral obliterative atherosclerosis in diabetics and to determine the predictive value of paraclinical investigations and angiography. Retrospective analysis of clinical, paraclinical and functional parameters of patients in whom pedal bypass was indicated, focused on the analysis of angiography. Of the 142 patients hospitalised with diabetic foot complications 32 were indicated for pedal bypass. All the patients were in the IV stage according to Fontain, the range of gangrene reached in average 2.7 grades of Wagners scale. Early success--i.e. functional artery reconstruction after hospital discharge was achieved in 18 patients (56%). Positive criteria for early success of the surgery involve short interval from gangrene development and serum albumin level above 26 g/l as an indicator of the nutritional state. Favourable angiographic criteria were: passage free arteries of dorsum pedis (ADP, ATP, a. plantaris, ATA) in the length of 10 cm free from focal stenoses, presence of numerous collaterals of legs and dorsum pedis, opacification of metatarsal and digital arteries. Pedal bypass is an efficient method of treatment for obliterative processes of lower extremities in diabetics with involvement of leg arteries. On the basis of our results this procedure can be recommended after careful preoperative staging and analysis of angiography as the method of treatment. It is necessary to perform the operation as soon as possible regarding the worsened nutritional and healing potential of the organism in the case of gangrene. Providing the surgery is properly indicated and performed it significantly improves the life quality of the patient. (Tab. 5, Fig. 1, Ref. 22.)