DR RAVUL JINDAL DR.TARANVIR KAUR

VASCULAR AND ENDOVASCULAR SURGEON FORTIS HOSPITAL

MOHALI

Diabetes and peripheral vascular disease

MAGNITUDE OF DIABETES

42 million Indians are diabetics Estimated number of diabetics by 2025- 70 million

By 2030, every fifth person with diabetes will be an Indian

Real burden of the disease is due to its associated complications

Myths

Diabetes only causes heart disease

Major Clinical Manifestations

Transient ischemic

attack

Angina: • Stable

• Unstable

Ischemic

stroke

Myocardial

infarction

Peripheral arterial

disease: • Intermittent claudication

• Rest Pain

• Gangrene

• Necrosis

Myth 2

Rarely cause foot problems

Hardly any discussions or lectures

MAGNITUDE OF PROBLEM……….

Foot ulceration – Affects almost 20% of all diabetic patients

Limb amputation: Most feared consequence - 80% follow foot ulcer.

Myths 3- Amputation is unavoidable

> 90% of these foot can be saved

Proper treatment

Myth 4

Most of the ulcers are neuropathic

Rare to have arterial component

What is a diabetic foot?

Neuropathy (>60%) Ischemia(15-20%)

Infection

PATHOGENESIS OF DIABETIC FOOT ULCER……

Motor dysfunction

Sensory dysfunction

Autonomic dysfunction

Early infection

Localized infection +

ulcer

Bilateral neuropathic ulcer

How to evaluate a patient ?

Associated risk factors

> age 50

Smoke

Hypertension

High cholesterol

Family history of heart attack, or stroke

Tuning fork test

Light touch test

Monofilament test

Testing vibration sensation with biothesiometer

Reading > 30-40volts – higher risk

Investigations

Ankle brachial pressure index

Duplex study

Angiogram

What is my first line of treatment?

PREVENTION

Daily inspection by patient – cheapest + most effective + easiest method

Soft leather or athletic foot wear

Patient education

Prophylactic skin and nail care

White cushion stockings – easy identification with weak eyes

Strict sugar control

An orthowedge – removes pressure on ulcer when we walk

Case 1 Distal arterial occlusion

SFA to ATA bypass

Case 2 Distal reconstructions

Take home message

Prevention is better than cure

Most of the ischemic foot in diabetics can be treated

Must evaluate both for neuroathy and PVD in all patients with diabetes

THANKS