Saving The Limb In Diabetics With Disease Of The Leg Or Foot

Main Category: Diabetes
Also Included In: Vascular
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Endovascular treatment for arterial recanalization in diabetic patients with critical limb ischemia (CLI) and foot lesions is currently accepted and indicated as the first choice treatment.

In most cases, different or multiple arterial accesses must be considered, and antegrade CFA* is the treatment of choice. Other options include retrograde popliteal, proximal retrograde anterior tibial, distal retrograde or antegrade pedal, and distal retrograde posterior tibial. These treatments can also be explored in combination. This was explained by Dr. Marco Manzi, Chief, Policlinico Abano Terme (Vincenza, Italy) at the 37th annual VEITHsymposium™ at the Hilton Hotel (New York, NY).

Dr. Manzi pointed out that different kinds of techniques must be considered for a "tailored" endovascular approach related to the grade of arterial disease. The length of lesions, wound related artery and the anatomical site of foot wounds are some considerations. The initial differentiation is between non-calcificated and calcificated arteries. With calcified arteries, it is mandatory to use a coronaric-like strategy in order to avoid any intimal dissection in both focal and long stenosis/occlusions.

"It is possibile to decide for a subintimal dissection as "the last resort" but we must know that we will have few probabilities to get the true lumen distally and many to compromise collaterals. Most failed procedures will be in this group, in our experience around 12-15% of all patients," explained Dr. Manzi.

In non calcificated arteries both subintimal and intraluminal techniques can be performed with a very high acute success rate and final limb salvage rate.

Low profiles, balloons and guidewires can be used for tibial vessels in non-calcificated situations; 0,014 platforms are mandatory for foot arteries and calcificated tibial vessels. Pedal-plantar Loop techniques, when possibile, avoid retrograde distal punctures and permit the rescue of ruptures or dissections with a statistical significative improvement in TcPO2 post-procedural measurements.

Sidebar:

CLI is a severe obstruction of the arteries which seriously decreases blood flow to the extremities (hands, feet and legs) causing severe burning pain, skin ulcers or sores. CLI is often present in individuals with severe peripheral arterial disease. Patients often awake at night from the pain. CLI is not to be ignored. Patients should consult a vascular surgeon who may offer conservative treatment or an intervention such as a stent.

* Antegrade CFA: The preferred vascular access to perform percutaneous intervention of the infrapopliteal vessels.

Source:
VEITHsymposium

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