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Diabetic Foot Interventions

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Endovascular Vs Surgery in Diabetic Foot Patients

Dr. Ravul Jindal MS FRCS FAMS FIVS Director Vascular Surgery (President Venous Association of India) Fortis Hospital Mohali, India

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Diabetic Foot Interventions

  1. 1. Dr Ravul jindal MS FRCS FAMS FIVS Director vascular surgery President Venous Association of India Fortis Hospital Mohali India www.indianvascularsurgery.com Endovascular vs Surgery in diabetic foot patients
  2. 2. Correct choice of treatment at the right time saves life and limbs avoids unnecessary costs
  3. 3. Current scenario The choice of Endovascular therapy (EVT) first vs surgical bypass for patients with tissue loss, PAD, and diabetes is currently much debated A recent comprehensive evidence-based review could find no clear evidence favouring EVT vs open bypass No randomized trials have been performed in patients with diabetes between these two techniques
  4. 4. • Advantages – Durable – Effective (limb salvage / symptom relief) • Disadvantages – Morbidity & Mortality (5%) – Poor long term patency BK – Surveillance – Potentially morbid Surgical Bypass
  5. 5. Catheter based interventions • Advantages – Effective (limb salvage / symptom relief) – Non-invasive – Low Morbidity & Mortality – Can be repeated • Disadvantages – Poor long term patency – May have to be repeated – Expensive!
  6. 6. Anatomical Factors Location Morphology of the lesion (TASC) Guidelines  Iliac: A,B,C – Catheter  Femoro-popliteal: A, B – Catheter  Tibial – Catheter if possible
  7. 7. `
  8. 8. TASC -Femoral-Popliteal Lesions
  9. 9. Long SFA occlusion
  10. 10. Bilateral SFA occlusions TASC D right side
  11. 11. TASC D Aortoiliac occlusion Patient condition
  12. 12. COST
  13. 13. Distal reconstructions
  14. 14. Left CLI with previous CABG Poor conduit on other side
  15. 15. What u want to do here ?
  16. 16. PAD: Endovascular Intervention, Surgery & Amputation Trends: 1996-2006 100 200 300 400 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Numberofprocedures/100,000Medicarebeneficiaries Years J Vascular Surgery 2009; 50:54-60 Total endovascular interventions RR=3.3; 95% CI 2.9-3.8 Major LE amputation RR=0.71; 95% CI 0.7-0.8 LE bypass surgery RR=0.58; 95% CI 0.5-0.7 3x growth in endovascular interventions
  17. 17. A clinical practice guideline by the SVS in collaboration with the American Podiatric Medical Association and the SVM JVS 2016 In functional patients with long-segment occlusive disease and a good autologous conduit, bypass is likely to be preferable In the setting of tissue loss and diabetes, prosthetic bypass is inferior to bypass with vein conduit
  18. 18. Conclusion A balanced view would acknowledge that both EVT and open surgery are important means of revascularization as part of a comprehensive approach to functional limb salvage in patients with diabetes The choice of intervention likely depends on the degree of ischemia, the extent of arterial disease, the extent of the wound, the presence or absence of infection, and the expertise of the practitioner

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