Evaluation and Management of Peripheral Arterial Disease in Type 2 Diabetes Mellitus
نویسنده
چکیده
The aim of present study was to a) assess the type and the distribution of peripheral arterial disease in diabetic patients presenting to the Endocrine Clinic. b) Plan revascularization and limb salvage of the affected limbs. During the past one year we evaluated and managed eleven patients of type 2 Diabetes and limb-threatening lower extremity ischemia from the moment of diagnosis to revascularization and limb salvage. These patients presented with predominant ischemic symptoms and signs. The patients were subjected to a complete clinical evaluation, recording of the Ankle Brachial Index, Color Doppler Scan and Digital Subtraction Angiography (DSA) of the lower limbs. Depending on the type of the lesion surgery or angioplasty procedures was performed. We had eleven patients who had presented with an ischemic limb. The mean age of the patients was 60.4±5.2 years and duration of diabetes was 12.4 ± 4.1 years. The presentation was ischemic ulcer on the great toe in 2/11 (22.2%), gangrene 2/11 (11.1%) one of them had bilateral gangrene, claudication and rest pain in 7/11 (44.4%).The peripheral pulses dorsalis pedis and posterior tibial was absent or feeble in 10/11 (90.9%), femoral artery pulses were feeble in 54.5% (6/11). The ankle brachial index was 0.55±0.24. The findings on the Duplex ultrasound scan and DSA were comparable. DSA had an additional advantage of demonstrating the arterial vascular anatomy of the lower limb. The lesions seen were (i) Non visualization of small arteries dorsalis pedis and posterior tibial in 3/11 (27.3%). Aortic disease was present in 3/11 (27.3%). Ilio-Femoral lesion in 36.4% (4/11) and Popliteal artery aneurysm 9.1% (1/11). . Surgery with vascular graft was done in 36.4% (4/11) and angioplasty and stent placement in 18.2% (2/11). There was a significant improvement post procedure. Amputation was done in 27.3% (3/11). The patient with bilateral gangrene underwent bilateral below knee amputation The patients who present with features of peripheral vascular disease should undergo recording of ankle brachial index, Duplex ultrasonography and angiography. They should be offered limb salvage revascularization procedure.
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تاریخ انتشار 2004