Download - 糖尿病足病変・壊疽 ~足の切断を免れるために~
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Sep. 8, 2009
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210074100
82,0001524
5 32DM Epidemic in the USA
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1370162022102007
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50.6% = 4501.6% = 7.20.6% = 2.7570
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Moulik PK, et al: Diabetes Care 26:491-494,2003
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J Vasc Surg 45 (Suppl S) : S5-S67, 2007
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(ankle-brachial index; ABI)0.9 ~ 1.3ABI or Norman PE, etal: Diabetes Care 29:575-580,2006ABI or Resnick HE, etal: Circulation 109:733-739,2004
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PAD(2001~2003ABI 0.9 263/39067.6 vs 2.7%Maeda Y: Peripheral arterial disease and diabetes. Angiology Frontier 7: 17-23, 2008
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PADMaeda Y: Peripheral arterial disease and diabetes. Angiology Frontier 7: 17-23, 2008
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ADAPADPAD
ABIPAD
51ABI50 ADA: Peripheral arterial disease in people with diabetes. Diabetes Care 26:333-341,2003
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HbA1cPAD26Selvin E, et al: Ann Intern Med 141: 421-431,2004Norgren L, et al: J Vasc Surg 45(I Suppl): S5-S67,2007Norgren L, et al: J Vasc Surg 45(I Suppl): S5-S67,2007
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Critical limb ischemia: CLI)
11Wolfe JHN: Br J Surg 11: 153-157, 1986
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Norgren L et al. Eur J Vasc Endovasc Surg 33(1 Suppl).S1, 2007
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PADBhatt DL et al. JAMA 295: 180-189, 2006
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CAD, CVD, PAD polyvascular disease REACH Registry Investigators: JAMA 295(2); 180-189, 2006
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862008227220ABI
ABI: Rt. (-), Lt. 0.50
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D-CT
100% 100% 100% 100% 100%
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SPP
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SPPmmHg%perfusion =
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(skin perfusion pressure; SPP)Right Foot Dorsal18 mmHgRight Foot Plantar18 mmHg
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Right Foot Dorsal27 mmHg
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Right Foot Dorsal60 mmHgSPPOne straight line
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62 200520071118, : 90%, 90% 20071217. 200712200821
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SPP 53 mmHg 94 mmHg 58 mmHg 74 mmHgmmHg%perfusion =
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75
2
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Moist wound healing
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(NPWT) Vacuum Assisted Closure (VAC) 23
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NPWT (VAC)
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1 week 2 week
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5 week 7 week
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9 week 11 week
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15 week 9 month
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675052 652007122620081, 3/ 2008716
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NPWT
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Vascular laboCVTABITBISPP)
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ABI0.550.473.5m/s5.085%75%
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X-P CT/CTA MRI/MRA Angiography/DSA
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88200712201221200812564
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2008618
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710
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NPWT
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10/310/24
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12/5
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=77.7% (167/215)=76.9% (40/52)
8 (10%)4 (5%)2008/6/6~2009/7/31 78 83 (31
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ABI
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*CTAAAACFA10cm/sdistal occlusion patternCFApost stenotic pattern