Authors
Korotkikh S.A.1, 3, Vechorko V.I.1, 2, Dzhurakulov S.R.1, 2, Viktorov N.V.2, Tashliev K.V.1, Anosov V.D.1, 2, Razuvaev E.A.1, Khlebnikov V.Yu.3
1 Municipal Clinical Hospital №15 named after O.M. Filatov, Moscow
2 N.I. Pirogov Russian National Research Medical University, Moscow
3 Kirov State Medical University, Kirov
Abstract
Diseases of the arteries of the lower extremities are extremely widespread in patients with diabetes mellitus. Patients with multilevel atherosclerotic lesion of the arteries of the lower extremities on the background of diabetes mellitus have a high risk of critical ischemia, and in accordance with this, the number of amputations and the number of deaths increases. Our clinical case describes the importance of timely revascularization of the arteries of the lower extremities in patients with diabetes mellitus. The possibility of simultaneous surgery in such patients, including endovascular recanalization with balloon angioplasty and distal amputation, which allows to preserve the supporting function of the lower limb. Our article presents a clinical case of successful repeated retrograde endovascular treatment followed by amputation of the middle and distal phalanx of the little digit of the right lower limb in a patient with a lesion of the arteries of the tibia on the background of diabetes mellitus.
Keywords: diabetic foot, peripheral vascular diseases, endovascular procedure, chronic limb threatening ischemia, transluminal balloon angioplasty.
References
1. Fowkes FGR, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet 2013; 382: 1329-40.
2. Mustapha JA, Katzen BT, Neville RF, Lookstein RA, et al. Disease burden and clinical outcomes following initial diagnosis of critical limb ischemia in the medicare population. JACC Cardiovasc Interv 2018; 11: 1011-2.
3. Arutyunyan S.O., Zhdanovich K.V., Puzdryak P.D., Gusinkiy A.V., Shlomin V.V., Kucherenko V.S., Fionik O.V. Early or delayed revascularization in patients with peripheral arterial disease: how to make the right choice? Bulletin of Pirogov National Medical & Surgical Center. 2024; 19(3): 54-57. (In Russ.) doi: 10.25881/ 20728255_2024_19_3_54.
4. Conte M.S. et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg. Mosby Inc. 2019; 69(6): 3S-125S.e40.
5. Using Multidisciplinary Teams to Improve Outcomes for Treating Chronic-Limb Threatening Ischemia. Wolf, Hannah et al. Annals of Vascular Surgery. 107: 37-42.
6. Jakubiak, G.K.; Pawlas, N.; Cieślar, G.; Stanek, A. Pathogenesis and Clinical Significance of In-Stent Restenosis in Patients with Diabetes. Int. J. Environ. Res. Public Health. 2021; 18: 11970.
7. Popitiu MI, Alexandrescu VA, Clerici G, Ionac S, et al. Angiosome-Targeted Infrapopliteal Angioplasty: Impact on Clinical Outcomes-An Observational Study. J Clin Med. 2024; 13(3): 883.
8. Comparative Outcomes of Targeted Versus Nontargeted Angiosome Revascularization for Diabetic Foot Wounds Impact of Target Arterial Path on Wound Healing. Pinelo, Andreia et al. Annals of Vascular Surgery. 10: 233-243.
9. Yap T, Silickas J, Weerakkody R, Lea T, et al. Predictors of outcome in diabetic patients undergoing infrapopliteal endovascular revascularisation for chronic limb-threatening ischaemia. J. Vasc. Surg. 2021.
