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Neo Innovation of Diabetic Foot Management, Vascular Surgery Experiments

Explores diabetic foot complications, vascular surgery treatment through revascularization approaches, and multidisciplinary management strategies including AI and wound therapy for improved patient outcomes.

Health & Medicine◦
Related topics:
Vascular Surgery Topics• Wound Care•Saudi Arabia Insights• Blood Vessels•
Neo Innovation of Diabetic Foot Management, Vascular Surgery Experiments KHALID RAJHI MD FACS Consultant of Vascular & Endovascular Surgery Lead of Vascular Surgery, Jazan Health Cluster, Saudi Arabia
No Financial Disclosure
Diabetes • Noncommunicable diseases threaten population health in many countries • Diabetes mellitus is of growing concern because of its prevalence and association with adverse health outcomes • Its complications pose a serious threat to human health and have become a global public health issue • Diabetic foot, affect 15% of all diabetic globally, 15– 20% may require amputation • DFU account for up to 24% mortality in patients with DM
• 17.7 % the prevalence of DM is around 18% among beneficiaries in a public health care system ‑ 1 • Over 90% of patients with diabetes have type 2 DM (T2DM) 2 1- Alghnam, et al. Int J Environ Res Public Health; 2021 World Health Survey of Saudi Arabia; 2019 2- Jia, W. et al. Diabetes Metab. Res.(2019)
WHO Definition • Diabetic foot Infection, ulceration or destruction tissues and bones with associated neuropathy and occlusive arterial disease in a patient with DM
• Ogbera & Fasanmade et al (2015), reported - 41.5% of DM patients have foot at risk - Type II diabetes account for 98.1% - Mean duration before development of DF is 10.8yrs • Pathogenesis - Peripheral Neuropathy 80 – 90% (Sensory - Motor - Autonomic) - Peripheral vascular disease 30-40% - Neuroischemic disease
Panvasculopathy in Diabetes Mellitus • Macroangiopathy include atherosclerosis of large and medium arteries • Microangiopathy includes endothelial damage to vessels between primary arterioles and venules, vascular basement membrane thickening, microthrombosis, platelet and red blood cell adhesion aggregation, and microcirculatory disorders
DIABETIC PANVASCULAR DISEASE - Cardiovascular disease: ischemic heart disease peripheral arterial disease - Cerebrovascular disease - Nephropathy - Retinopathy - Neuropathy
Diabetic Peripheral Vasculopathy • One of the most important and common vascular complications in patients with T2DM. • In such patients, DPVD increases the risk of major adverse limb events such as amputation. • DPVD can manifest as diabetic foot syndrome and peripheral arterial disease (PAD), which seriously affect the quality of life of patients with diabetes. • Peripheral arterial disease is traditionally considered to be dominated by large artery atherosclerosis. • In fact, PAD is often accompanied by local and systemic microangiopathy. • Multivessel endothelial dysfunction can manifest as microangiopathy (either exclusively or with other diseases), such as capillary basement membrane thickening, endothelial hyperplasia, oxygen tension reduction, and hypoxia, affecting peripheral nerve function. • Pre-DM can affect blood vessels and accompanying nerves. • The chronic course of DM might have further adverse effects under poor glycemic control. • An increase in postprandial glucose plays an important role in the development of peripheral vascular disease in DM.
Management of diabetic foot is multi-disciplinary
Diabetes mellitus should have an annual foot evaluation using the Semmes-Weinstein monofilament test to assess for peripheral neuropathy Diabetic foot ranges from foot at risk to frank gangrene
” by Vuorlaakso et al. (2023) Retrospective cohort study of long-term outcomes and prognostic factors for survival after lower extremity amputation in patients with diabetes. a relationship between frailty (especially advanced age), CKD and other multimorbidities such as PAD
• Following amputation, mortality ranges: - from 13 to 40% in one year, 35 to 65% in three years, 39 to 80% in five years
Chronic limb-threatening ischemia CLTI • a severe form of peripheral arterial disease PAD, associated with : - increased risk of amputation - mortality - significantly impaired quality of life • The 2 primary revascularization approaches for CLTI are: - Open surgery - Endovascular therapy
Recent Trials of Revascularization • Best Endovascular versus best Surgical Therapy in patients with CLI (BEST-CLI) • Bypass versus Angioplasty for Severe Ischemia of the Leg (BASIL-2) • Regardless of the chosen strategy, early referral of patients with diabetes and CLTI to a specialist team within a multidisciplinary environment is crucial.
• Their findings, highlight the need for an individualized revascularization strategy which accounts for underlying comorbidities, risk factors, disease severity, availability of suitable bypass conduits, surgical risks, and timely access to procedures
• BASIL-2 Study Finds Better Amputation-Free Survival With Endovascular-First Treatment Strategy Versus Vein Bypass in CLTI Patients Requiring Infra- popliteal Revascularization
Different Approachs of Revasculirization
Negative Pressure Wound Therapy Vaccum Assisted Closure VAC
AI in DFU Management
Comprehensive care should encompass essential elements - smoking cessation - glycemic control - adequate debridement - infection control - offloading - patient education