Diabetic foot: New therapeutic techniques for reperfusion of the plantar arch
By the term diabetic foot we mean a combined disorder of nerves, vessels, musculoskeletal and skin that leads to the development of ulcers and inflammation in the foot with the final result of ulcers, gangrene and amputation.
Diabetic neuropathy and angiopathy constitute the basic background. Neuropathy causes anesthesia, so the patient does not perceive microtraumas. In addition, it causes damage to the motor nerves leading to a disorder of the architecture of the limb (osteoarthropathy). Finally, damage to the autonomic nervous system causes anhidrosis, dry skin and skin detachment, most often at pathological pressure points, the calluses or better known as calluses caused by the disorder of the normal architecture of the foot. In these small wounds (ulcers) we have the entry of microbes and due to reduced blood circulation (angiopathy), development into inflammation with inability to heal, osteomyelitis and diabetic gangrene with risk of amputation.
Many specialties contribute to the prevention of diabetic ulcers: podiatrist (footwear, plantar fasciitis), diabetologist (sugar regulation, hypertension, smoking cessation), vascular surgeon and orthopedic surgeon for the treatment of osteoarthropathy. More specifically, the role of the vascular surgeon is preventive with assessment of skin lesions and control of blood circulation, but mainly therapeutic with opening the arteries. It is always necessary for every ulcer to heal to provide rich blood flow to the toes of the foot.
Today, the development of materials and means allows us to re-vascularize the arteries of the foot in the diabetic foot (plantar arch reperfusion) without surgery, percutaneously, intravascularly with local anesthesia and with a one-day hospitalization.
Reperfusion is essentially the opening of the pathological “clogged” arteries of the foot that will allow the ulcer to heal and avoid gangrene and amputation. The materials we use are special wires, catheters, balloons and stents with or without medication, of very small diameter and very strong in piercing capacity so that they can pass through the total blockages of the very small peripheral arteries of the foot, without destroying them. Of course, the revolution in the effectiveness of the above techniques is the recent creation of special rooms for such interventions, the so-called hybrid ones.
The hybrid room is an innovation in operating rooms that combines the advantages of the classic operating room with those of a powerful angiographer. Thus, hybrid open and endovascular interventions are performed at the same time, faster, with less radiation and with greater efficiency. In practice, in these robotic fluoroscopic machines we see the very small arteries of the foot very clearly and we intervene with comfort and safety, which in classic fluoroscopic machines was particularly difficult and unsafe.
We are therefore pleased to say that, in the modern hybrid room of the Inter-Balkan Medical Center of Thessaloniki we have the most modern materials and means but mainly the know-how and training to carry out these demanding operations, providing a solution to previously condemned diabetic patients. Technology today is at the service of science and allows us to believe that no diabetic foot is now amputated.
