당뇨병성 족부 괴저에서 수술 전 시행한 경피적 경혈관 혈관성형술의 유용성
Usefulness of Percutaneous Transluminal Angioplasty before Operative Treatment in Diabetic Foot Gangrene
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: Diabetic foot gangrene has a high morbidity rate and a great influence on the quality of life. Amputation is an appropriate treatment if conservative treatment is impossible according to the severity of gangrene and infection. The purpose of this study was to evaluate the usefulness of preoperative percutaneous transluminal angioplasty for the postoperative outcome. Materials and Methods: From February 2013 to April 2016, among 55 patients with diabetic foot gangrene, who require surgical treat- ment, percutaneous transluminal angioplasty was performed on patients with an ankle brachial index (0.9 and stenosis) 50% on angio- graphic computed tomography. The study subjects were 49 patients, comprised of 37 males (75.5%) and 12 females (24.5%). The mean age of the patients was 70.0±9.6 years. The treatment results were followed up according to the position and length of the lesion and the changes during the follow-up period. Results: As a result of angiography, there were 13 cases of atherosclerotic lesions in the proximal part, 11 cases in the distal part and 25 cases in both the proximal and distal parts. As a result of the follow-up after angiography, in 13 patients, the operation was not per- formed and only follow-up and dressing were performed around the wound. Sixteen patients underwent debridement for severe gan- grene lesions and 20 patients, in whom the gangrene could not be treated, underwent amputation (ray amputation or metatarsal ampu- tation, below knee amputation). Conclusion: Preoperative percutaneous angioplasty in diabetic foot gangrene patients with peripheral vascular occlusive disease is sim- ple, and 59.2% of the patients with diabetic foot gangrene could be treated by conservative treatment or debridement.
Abstract
Purpose: Diabetic foot gangrene has a high morbidity rate and a great influence on the quality of life. Amputation is an appropriate treatment if conservative treatment is impossible according to the severity of gangrene and infection. The purpose of this study was to evaluate the usefulness of preoperative percutaneous transluminal angioplasty for the postoperative outcome. Materials and Methods: From February 2013 to April 2016, among 55 patients with diabetic foot gangrene, who require surgical treat- ment, percutaneous transluminal angioplasty was performed on patients with an ankle brachial index (0.9 and stenosis) 50% on angio- graphic computed tomography. The study subjects were 49 patients, comprised of 37 males (75.5%) and 12 females (24.5%). The mean age of the patients was 70.0±9.6 years. The treatment results were followed up according to the position and length of the lesion and the changes during the follow-up period. Results: As a result of angiography, there were 13 cases of atherosclerotic lesions in the proximal part, 11 cases in the distal part and 25 cases in both the proximal and distal parts. As a result of the follow-up after angiography, in 13 patients, the operation was not per- formed and only follow-up and dressing were performed around the wound. Sixteen patients underwent debridement for severe gan- grene lesions and 20 patients, in whom the gangrene could not be treated, underwent amputation (ray amputation or metatarsal ampu- tation, below knee amputation). Conclusion: Preoperative percutaneous angioplasty in diabetic foot gangrene patients with peripheral vascular occlusive disease is sim- ple, and 59.2% of the patients with diabetic foot gangrene could be treated by conservative treatment or debridement.
참고문헌 (15)
- Reiber GE, "Levin and O'Neal's the diabetic foot", pp.3~22 (2008), Mosby
- LoGerfo FW, "Trends in the care of the diabetic foot. Expanded role of arterial reconstruction", Arch Surg, 127, pp.617~620 (1992)[DOI]
- Rosenblum BI, "Maximizing foot salvage by a combined approach to foot ischemia and neuropathic ulceration in patients with diabetes. A 5-year experience", Diabetes Care, 17, pp.983~987 (1994)[DOI]
- Faglia E, "Feasibility and effectiveness of peripheral percutaneous transluminal balloon angioplasty in diabetic subjects with foot ulcers", Diabetes Care, 19, pp.1261~1264 (1996)[DOI]
- Hanna GP, "Infrapopliteal transcatheter interventions for limb salvage in diabetic patients: importance of aggressive interventional approach and role of transcutaneous oximetry", J Am Coll Cardiol, 30, pp.664~669 (1997)[DOI]
- Boulton AJ, "The global burden of diabetic foot disease", Lancet, 366, pp.1719~1724 (2005)[DOI]
- Beach KW, "Progression of lower-extremity arterial occlusive disease in type II diabetes mellitus", Diabetes Care, 11, pp.464~472 (1988)[DOI]
- Levin ME, "Preventing amputation in the patient with diabetes", Diabetes Care, 18, pp.1383~1394 (1995)[DOI]
- Gaspar L, "Contribution of prostaglandin E1 treatment in patients with critical limb ischemia", Int J Clin Exp Med, 9, pp.3227~3231 (2016)
- Flynn MD, "Diabetic angiopathy", pp.92~98 (1999), Arnold
- Caputo GM, "Assessment and management of foot disease in patients with diabetes", N Engl J Med, 331, pp.854~860 (1994)[DOI]
- Ouriel K, "Limb-threatening ischemia in the medically compromised patient: amputation or revascularization?", Surgery, 104, pp.667~672 (1988)
- Choi D, "Frequency of combined atherosclerotic disease of the coronary, periphery, and carotid arteries found by angiography", Korean Circ J, 29, pp.883~890 (1999)[DOI]
- Wolosker N, "Peroneal artery approach for angioplasty of the superficial femoral artery: a case report", Vasc Endovascular Surg, 37, pp.129~133 (2003)[DOI]
- 한승환, "당뇨병성 족부 궤양 및 감염에서의 절단", 대한족부족관절학회지, 18(1), pp.8~13 (2014), 대한족부족관절학회[DOI]