RESUMO
It was done the prospective study of the examination results of 40 patients with diabetes mellitus. All patients were divided into 2 groups for study of 25-OH-vitamin D effect, cholesterol, triglycerides in blood serum on the nature of diabetes mellitus. The first group included patients with ulcero-necrotic injuries in case of neuro-ischemic forms of diabetic foot syndrome. The second group included patients without such injuries. It was significantly determined that there was more neuro-ischemic injuries in case of 25-OH-vitamin D level less than 30 nmol/l. Injuries are connected with reduction of arterial inflow because of osslusive-stenotic lesions of arteries. 25-OH-vitamin D level less than 30 nmol/l is a marker of neuro-ischemic injuries of foot in case of diabetes mellitus. This indication is more specific than cholesterol and triglycerides levels.
Assuntos
25-Hidroxivitamina D 2/sangue , Colesterol/sangue , Diabetes Mellitus , Pé Diabético , Triglicerídeos/sangue , Adulto , Biomarcadores/sangue , Diabetes Mellitus/sangue , Diabetes Mellitus/fisiopatologia , Pé Diabético/sangue , Pé Diabético/etiologia , Pé Diabético/fisiopatologia , Feminino , Humanos , Isquemia/sangue , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estatística como AssuntoRESUMO
The authors investigated peculiarities of occlusive and stenotic arterial lesions influencing the pattern of revascularization in patients presenting with a neuroischaemic form of diabetic foot syndrome. We examined a total of 106 patients with a neuroischaemic form of diabetic foot syndrome and undergoing treatment at the City Municipal Centre for Diabetic Foot in the City of Minsk. In order to visualize the arteries in 82 (77.4%) cases we used contrast-enhanced angiography, in 16 (15.1%) cases - CT angiography, and in 8 (7.5%) cases a combination of the both methods was used. The overwhelming majority of patients were found to have distal occlusion with lesions of three and two crural arteries. Standard approaches made it possible to perform revascularization only in 46 (43.9%) patients in the examined group. A promising trend of improving rendering care for patients with a neuroischaemic form of diabetic foot syndrome and decreasing the rate of high amputations consists in thrther development and implementation of hybrid technologies of limb revascularization, as well as adequate material and technical provision of such interventions.
Assuntos
Angiografia/métodos , Artérias , Pé Diabético , Salvamento de Membro/métodos , Extremidade Inferior/irrigação sanguínea , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Artérias/fisiopatologia , Artérias/cirurgia , Pé Diabético/diagnóstico , Pé Diabético/etiologia , Pé Diabético/fisiopatologia , Pé Diabético/cirurgia , Neuropatias Diabéticas/complicações , Neuropatias Diabéticas/fisiopatologia , Feminino , Humanos , Isquemia/complicações , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Fluxo Sanguíneo Regional , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
The prospective study includes 142 patients with necrotic ulcers of feet in frames of the neuroiscemic form of the diabetic foot syndrome. 60 patents had revascularization procedures, of them 14 had open vascular operations and 46 had endovascular procedures. The high efficacy of revascularization in the group of patients with neuroiscemic form of the diabetic foot syndrome. The procedure allowed to decrease the rate of critical limb ischemia and high amputations (p=0,037).
Assuntos
Amputação Cirúrgica/métodos , Pé Diabético , Neuropatias Diabéticas/complicações , Salvamento de Membro/métodos , Úlcera/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Pé Diabético/etiologia , Pé Diabético/fisiopatologia , Pé Diabético/cirurgia , Neuropatias Diabéticas/fisiopatologia , Feminino , Humanos , Isquemia/complicações , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Úlcera/etiologiaRESUMO
Treatment results of 203 patients with critical ischemia by neuroischemic form of the diabetic foot sindrome were analyzed. 45 patients had open, endovascular or hybrid vascular reconstructions. The method was decised basing on the results of angiographic studies. The support function was saved in 34 (75,6%) cases of 45 operated patients. Revascularization proved to be an effective and reasonable method of surgical intervention by critical ischemia caused by the neuroischemic form of the diabetic foot syndrome.
Assuntos
Complicações do Diabetes/prevenção & controle , Pé Diabético/cirurgia , Gangrena/cirurgia , Isquemia/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Amputação Cirúrgica/estatística & dados numéricos , Angiografia , Circulação Sanguínea , Estado Terminal , Complicações do Diabetes/fisiopatologia , Pé Diabético/etiologia , Pé Diabético/fisiopatologia , Feminino , Pé/irrigação sanguínea , Gangrena/etiologia , Gangrena/fisiopatologia , Humanos , Isquemia/etiologia , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Administração dos Cuidados ao Paciente , Equipe de Assistência ao Paciente , Recuperação de Função Fisiológica , Resultado do Tratamento , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/normas , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricosRESUMO
The article presents two clinical case reports concerning successful surgical management of acutely impaired mesenteric haemocirculation accompanied and followed by the development of arterial and venous infarction of the large intestine.
Assuntos
Oclusão Vascular Mesentérica/cirurgia , Trombectomia/métodos , Trombose/cirurgia , Idoso , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Laparoscopia , Laparotomia/métodos , Oclusão Vascular Mesentérica/diagnóstico , Trombose/diagnósticoRESUMO
The article deals with diabetic foot syndrome defined as a multidisciplinary problem. A reconstructive vascular operation in critical ischaemia on the background of diabetic foot syndrome is herein shown to be an efficient and justified intervention. Revascularization makes it possible to carry out sparing resections on the foot, to appropriately cope with the events of lower-limb critical ischaemia, and to reliably decrease the rate of high amputations.