cardiovascular-agents and Diabetic-Foot

Diabetic foot ulceration (DFU) is associated with high morbidity and mortality, and represents the leading cause of hospitalization in patients with diabetes. Peripheral arterial disease (PAD), present in half of patients with DFU, is an independent predictor of limb loss and can be difficult to diagnose in a diabetic population. This review focuses on the evidence for therapeutic strategies in the management of patients with DFU. We highlight the importance of timely referral of patients presenting with a new foot ulcer to a multidisciplinary team, which includes vascular surgeons and interventional radiologists.

Topics: Anti-Bacterial Agents; Cardiovascular Agents; Combined Modality Therapy; Diabetic Foot; Endovascular Procedures; Evidence-Based Medicine; Humans; Hypoglycemic Agents; Patient Care Team; Peripheral Arterial Disease; Referral and Consultation; Risk Factors; Treatment Outcome; Vascular Surgical Procedures

Despite obvious progress in management of diabetes mellitus, the DM-related complications rate remains inadmissibly high. Macroangiopathy is known to rank first amongst complications of diabetes mellitus, and coronary artery disease remains to be the major cause of death. Analysed herein are peculiarities of the clinical course in diabetic patients presenting with coronary artery disease and lower limb critical ischaemia, followed by discussing the issues concerning drug therapy, preoperative examination, and methods of diagnosis in this cohort of patients prior to vascular operations, assessment of the preoperative risk, indications for coronarography and myocardial revascularization. Also presented are the results of the main clinical trials dedicated to preoperative myocardial revascularization, including those in diabetic patients with limb critical ischaemia, and finally highlighting current importance of optimizing approaches to managing and working out algorithms of treatment policy for diabetic patients with a combination of coronary artery disease, diabetes mellitus, and critical limb ischaemia.

Topics: Algorithms; Cardiovascular Agents; Clinical Protocols; Clinical Trials as Topic; Combined Modality Therapy; Coronary Angiography; Coronary Artery Disease; Diabetes Mellitus, Type 2; Diabetic Foot; Disease Management; Humans; Ischemia; Limb Salvage; Myocardial Revascularization; Preoperative Care; Risk Assessment; Severity of Illness Index; Survival Analysis

Diabetic foot (DF) is a chronic and highly disabling complication of diabetes. The prevalence of peripheral arterial disease (PAD) is high in diabetic patients and, associated or not with peripheral neuropathy (PN), can be found in 50% of cases of DF. It is worth pointing out that the number of major amputations in diabetic patients is still very high. Many PAD diabetic patients are not revascularised due to lack of technical expertise or, even worse, negative beliefs because of poor experience. This despite the progress obtained in the techniques of distal revascularisation that nowadays allow to reopen distal arteries of the leg and foot. Italy has one of the lowest prevalence rates of major amputations in Europe, and has a long tradition in the field of limb salvage by means of an aggressive approach in debridement, antibiotic therapy and distal revascularisation. Therefore, we believe it is appropriate to produce a consensus document concerning the treatment of PAD and limb salvage in diabetic patients, based on the Italian experience in this field, to share with the scientific community.

Topics: Amputation, Surgical; Angioplasty, Balloon; Cardiovascular Agents; Consensus; Diabetic Foot; Endovascular Procedures; Humans; Limb Salvage; Peripheral Arterial Disease; Predictive Value of Tests; Prevalence; Risk Factors; Treatment Outcome; Vascular Surgical Procedures

Topics: Amputation, Surgical; Angioplasty, Balloon; Cardiovascular Agents; Coated Materials, Biocompatible; Diabetic Foot; Humans; Leg; Limb Salvage; Peripheral Arterial Disease; Prosthesis Design; Prosthesis Failure; Risk Assessment; Risk Factors; Treatment Failure; Vascular Access Devices

Topics: Aged; Cardiovascular Agents; Comorbidity; Diabetic Foot; Diabetic Nephropathies; Disease Management; Dyslipidemias; Female; Glycated Hemoglobin; Guideline Adherence; Humans; Hypertension; Hypoglycemic Agents; Insulin; Kidney Failure, Chronic; Male; Middle Aged; Patient Compliance; Retrospective Studies; Secondary Prevention; Smoking