RESUMEN
Background Foot ulcer is a common complication of poorly controlled diabetes and peripheral vascular disease (PVD). The current standard of treatment for diabetic foot ulcers includes the management of underlying risk factors, wound debridement, use of antibiotics for infection, off-loading with cast, and revascularisation surgery. The glyceryl trinitrate (GTN) patch is currently off-licence in treating PVD or diabetic foot ulcers. This study aims to evaluate the effectiveness of the GTN patch in preventing amputation, improving pain control, and reducing the size of tissue loss (ulcer/gangrene) or localised ischaemic area. Method This is a pilot study of 30 patients who were started on the GTN patch from February 2020 to October 2021. Inclusion criteria were patients who have critical limb-threatening ischaemia (CLTI) and with no viable options or are at high risk for revascularisation, both endovascular and open surgery. Patients who were on a GTN patch for less than six weeks at the time of data collection or had unclear outcomes were excluded. The outcomes were retrospectively collected on prevention of amputation, improvement in pain control, and reduction in tissue loss (the size of ulcer/gangrene) or localised ischaemic area with the use of a GTN patch. The binomial test was used to compare the observed outcome of the GTN patch and the expected outcome, which was assumed to be 50% in this study. Results Ninety-three per cent (93%) of the patients who had GTN patches successfully avoided amputation (p<0.0001). Eighty-four per cent (84%) of patients reported better pain control (p=0.0022) and improvement in the size of ulcer/gangrene/localised ischaemic areas (p=0.0005). Conclusion The GTN patch is effective in preventing amputation, improving pain control, and reducing the size of ulcer/gangrene/localised ischaemic areas in patients who have end-stage CLTI and no viable options or who are at high risk for revascularisation surgery.
RESUMEN
Introduction Failure of infrainguinal bypass grafts remains a major problem tackled by vascular surgeons despite a meticulous surgical technique. All infrainguinal bypasses should go under routine surveillance to pick the grafts at risk for the prevention of graft failure. Objectives The aim was to find out if we were adhering to the European Society of Vascular Surgery (ESVS) guidelines in the management of chronic limb-threatening ischaemia (CLTI) patients, including postoperative follow-up and to monitor whether the patients were having postoperative duplex surveillance scans to pick any graft at risk. Methods All patients who underwent infra-inguinal bypass procedures for CLTI during the last eight months (from mid-January to mid-September 2023) in our vascular unit were included. Retrospective data were collected. Results A total of 38 patients had lower limb bypass procedures over the last eight months (from 15 January till 14 September 2023). However, two femoral-femoral (fem-fem) crossovers, one Ilio-popliteal, and one pedal bypass were excluded. Thus, a total of 36 patients were included in the study (n=34). The vast majority (n=27, 79.4%) had femoro popliteal bypass anastomosing distally to above knee (AK) or below knee (BK) popliteal artery, and the rest (n=7, 20.5%) had distal bypass (fem-distal or pop-distal bypass). Moreover, 18% of patients had amputation, 15% of patients died, and 61% of the remaining patients were on surveillance. Of those, who were not on surveillance, 44% of them had graft occlusion. Conclusion Surveillance can predict graft at risk, and the graft occlusion can be prevented by appropriate intervention. Every vascular unit should have its own post-procedural follow-up strategies.
