Σακχαρώδης διαβήτης: νευροπαθητικά και ισχαιμικά έλκη κάτω άκρων: παθογένεια - συμβολή στην αντιμετώπιση και εξέλιξη

Abstract

The aim of the present study was: a) to record the clinical course and the outcome of patients with Diabetic Foot (DF) during a follow-up period of six years; b) to identify risk factors for ipsilateral re-amputation. In the first part of our study, 256 patients (171 men, 85 women; mean age 65.31±10.25 years) with diabetic foot were included. These were divided into 3 groups according to the aetiology of the lesion: Group I: 87 patients with neuropathic ulcers Group II: 34 patients with purely ischaemic ulcers and Group III: 120 patients with neuroischaemic ulcers In all 3 groups, lesion location was recorded, while lesion severity was graded according to the Meggit-Wagner system. Neuropathy was diagnosed by the Neuropathy Disability Score (NDS), and presence of painful neuropathy was assessed by means of Neuropathy Symptom Score (NSS). Moreover, patients were examined for the presence of peripheral arterial disease. The latter was diagnosed by measuring Ankle-Brachial Index with a Doppler device, as well by typical symptoms (intermittent claudication), palpation of peripheral pulses and, where possible, DSA. We also recorded past history of ulceration or amputation, sex, age, DM type, metabolic control (HbA1c), DM duration, antidiabetic treatment, smoking habits, BMI, classical micro- and macrovascular complications (nephropathy, retinopathy, coronary disease, stroke) and other risk factors, such as hypertension and dislipidaemia. We sought to identify the causal pathway of ulceration, the duration of lesions, the frequency and duration of hospitalisation, the outcome of healing or not, as well as the likelihood of subsequent amputation or vascular intervention. We also addressed the management of diabetic foot, the recurrence of lesion or appearance of new ulceration and, finally, patient mortality. The second part of the study focused on the appearance or otherwise of ipsilateral re-amputation during a 6-year follow-up among patients who had previously sustained a minor or major amputation. Included were 121 patients with prior amputation, who were divided into 2 groups: group A (95 patients without re-amputation) and group B (26 patients with re-amputation). We aimed to identify risk factors leading to ipsilateral re-amputation. Examined potential risk factors included HbA1c, smoking, nephropathy, age, sex, BMI, severity of neuropathy, severity of ischaemia, aetiology and severity of lesion, anatomic location of lesion, patient compliance, vascular intervention, and angiographic findings). .......................................................................