DR RAVUL JINDAL DR.TARANVIR KAUR VASCULAR AND ENDOVASCULAR SURGEON FORTIS HOSPITAL MOHALI Diabetes and peripheral vascular disease
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DR RAVUL JINDAL DR.TARANVIR KAUR
VASCULAR AND ENDOVASCULAR SURGEON FORTIS HOSPITAL
MOHALI
Diabetes and peripheral vascular disease
MAGNITUDE OF DIABETES
42 million Indians are diabetics Estimated number of diabetics by 2025- 70 million
By 2030, every fifth person with diabetes will be an Indian
Real burden of the disease is due to its associated complications
Myths
Diabetes only causes heart disease
Major Clinical Manifestations
Transient ischemic
attack
Angina: • Stable
• Unstable
Ischemic
stroke
Myocardial
infarction
Peripheral arterial
disease: • Intermittent claudication
• Rest Pain
• Gangrene
• Necrosis
Myth 2
Rarely cause foot problems
Hardly any discussions or lectures
MAGNITUDE OF PROBLEM……….
Foot ulceration – Affects almost 20% of all diabetic patients
Limb amputation: Most feared consequence - 80% follow foot ulcer.
Myths 3- Amputation is unavoidable
> 90% of these foot can be saved
Proper treatment
Myth 4
Most of the ulcers are neuropathic
Rare to have arterial component
What is a diabetic foot?
Neuropathy (>60%) Ischemia(15-20%)
Infection
PATHOGENESIS OF DIABETIC FOOT ULCER……
Motor dysfunction
Sensory dysfunction
Autonomic dysfunction
Early infection
Localized infection +
ulcer
Bilateral neuropathic ulcer
How to evaluate a patient ?
Associated risk factors
> age 50
Smoke
Hypertension
High cholesterol
Family history of heart attack, or stroke
Tuning fork test
Light touch test
Monofilament test
Testing vibration sensation with biothesiometer
Reading > 30-40volts – higher risk
Investigations
Ankle brachial pressure index
Duplex study
Angiogram
What is my first line of treatment?
PREVENTION
Daily inspection by patient – cheapest + most effective + easiest method
Soft leather or athletic foot wear
Patient education
Prophylactic skin and nail care
White cushion stockings – easy identification with weak eyes
Strict sugar control
An orthowedge – removes pressure on ulcer when we walk
Case 1 Distal arterial occlusion
SFA to ATA bypass
Case 2 Distal reconstructions
Take home message
Prevention is better than cure
Most of the ischemic foot in diabetics can be treated
Must evaluate both for neuroathy and PVD in all patients with diabetes
THANKS
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