경피적 동맥확장술을 이용한 당뇨족 허혈의 치료 = Treatment of Vasculopathy in Diabetic Foot by Percutaneous Transluminal Angioplasty

다국어 초록 (Multilingual Abstract)

Purpose: In treating diabetic foot ulcers, satisfactory vascularity is an essential prerequisite. To improve vascularity, a bypass graft has long been carried out. Recently, however, percutaneous transluminal angioplasty (PTA) has also been tried since the PTA is less invasive than the bypass graft. However, publication demonstrating the improvement of vascularity after the PTA are lacking. Therefore, this study was designed to show usefulness of the PTA in treating vasculopathy of diabetic foot. Materials: and Methods This study included 30 feet of 24 ischemic diabetic foot patients. Inclusion criteria were diabetes (duration > 5 years) and a significant lower extremity ischemia, as determined by a transcutaneous oxygen pressure ($TcpO_2$) < 30 mmHg. The PTA was carried out in 61 arteries. PTA procedure was considered successful, when residual stenosis was less than 30%. The procedure was considered failed when residual stenosis was more than 50%. Residual stenosis between 30% and 50% was considered acceptable. For evaluation of PTA effect, foot $TcpO_2$ and infrared thermography were measured before and 7th day after PTA. Results: Immediately after PTA performed in 61 arteries, 58 and 3 arteries were evaluated as being successful and acceptable, respectively. Before PTA, average foot $TcpO_2$ was $12.6{\pm}8.8$ mmHg and its value was increased to $44.2{\pm}23.9$ on 7th day after PTA (p<0.01). Average skin temperature was $31.8{\pm}1.2^{\circ}C$ before PTA and it was increased to $33.5{\pm}1.1^{\circ}C$ on 7th day after PTA (p<0.01). Conclusion: PTA procedure increases tissue oxygenation of ischemic diabetic feet which do not have wound healing potential due to low tissue oxygenation, to the level of possible wound healing. In addition, PTA increases skin temperature of ischemic diabetic feet which can imply an improvement of peripheral circulation.

참고문헌 (Reference)

1 Cina C, "Utility of transcutaneous oxygen tension measurements in peripheral arterial occlusive disease" 1 : 362-, 1984

2 Wölfle KD, "Tibioperoneal arterial lesions and critical foot ischaemia: successful management by the use of short vein grafts and percutaneous transluminal angioplasty" 29 : 207-, 2000

3 Bharara M, "Thermography and thermometry in the assessment of diabetic neuropathic foot: a case of furthering the role of thermal techniques" 5 : 250-, 2006

4 Byrne P, "The use of transcutaneous oxygen tension, measurements in the diagnosis of peripheral vascular insufficiency" 200 : 159-, 1984

5 Nasr MK, "The increasing role of percutaneous transluminal angioplasty in the primary management of critical limb ischaemia" 23 : 398-, 2002

6 Jacqueminet S, "Percutaneous transluminal angioplasty in severe diabetic foot ischemia: outcomes and prognostic factors" 31 : 370-, 2005

7 Jude EB, "Optimal treatment of infected diabetic foot ulcers" 21 : 833-, 2004

8 Mayrovitz HN, "Functional microcirculatory impairment: a possible source of reduced skin oxygen tension in human diabetes mellitus" 52 : 115-, 1996

9 Capek P, "Femoropopliteal angioplasty. factors influencing long-term success" 83 : I70-, 1991

10 Yambe T, "Effect of the alternative magnetic stimulation on peripheral circulation for regenerative medicine" 59 : 174-, 2005

11 Dawson DL, "Critical limb ischemia" 9 : 159-, 2007

12 Kudo T, "Changing pattern of surgical revascularization for critical limb ischemia over 12 years: endovascular vs. open bypass surgery" 44 : 304-, 2006

13 Sun PC, "Assessing foot temperature using infrared thermography" 26 : 847-, 2005

14 Ballard JL, "A prospective evaluation of transcutaneous oxygen measurements in the management of diabetic foot problems" 22 : 485-, 1995

15 Pomposelli FB, "A decade of experience with dorsalis pedis artery bypass: analysis of outcome in more than 1000 cases" 37 : 307-, 2003