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Review: The management of tibial artery disease in diabetes

Department of Vascular Surgery, South Manchester University Hospital

Ray J Ashleigh

Radiology, South Manchester University Hospital

Amman Bolia

Department of Radiology, Leicester Royal Infirmary

Akhtar Nasim

Department of Vascular Surgery, South Manchester University Hospital, Akhtar.Nasim{at}smuht.nwest.nhs.uk

Foot ulceration and gangrene are important causes of morbidity in diabetic patients. Healing of such lesions requires surgical debridement of the infected and necrotic tissue, and restoration of pulsatile blood flow to the foot. As occlusive atherosclerosis of the tibial arteries is particularly common in diabetic patients, infrapopliteal revascularisation is often required. This has traditionally been accomplished by transluminal angioplasty or surgical bypass, with moderately good results. More recently, subintimal angioplasty has been proposed as an alternative, minimally invasive treatment to recanalise long arterial occlusions, with promising patency rates even in small vessels. Advanced reconstructive techniques, including local or free tissue flaps can be used to accelerate healing of large foot wounds after successful revascularisation. Treatment of diabetic tibial artery disease is challenging and requires an aggressive multidisciplinary approach, with co-operation between diabetologists, interventional radiologists, vascular and plastic surgeons.

Key Words: diabetes mellitus • peripheral vascular disease • angioplasty • arterial bypass.

References

• Bainton D., Sweetnam P., Baker I., Elwood P. Peripheral vascular disease: consequence for survival and association with risk factors in the Speedwell prospective heart study. Br Heart J 1994;72:128-32.[Abstract/Free Full Text]
• Brand FN, Abbott RD, Kannel WB Diabetes, intermittent claudication, and risk of cardiovascular events. The Framingham study. Diabetes 1989; 38:504-9.[Abstract]
• Gensler SW, Haimovici H., Hoffert P., Steinman C., Beneventano TC Study of vascular lesions in diabetic, nondiabetic patients. Clinical, arteriographic, and surgical considerations. Arch Surg 1965;91:617-22.[Abstract/Free Full Text]
• Williams DRR. Hospital admissions of diabetic patients: information from hospital activity analysis. Diabet Med 1985;2:27-32.[Medline] [Order article via Infotrieve]
• World Health Organisation (Europe) and International Diabetes Federation (Europe). Diabetes care and research in Europe: the Saint Vincent declaration. Diabet Med 1990;7:360.[Web of Science][Medline] [Order article via Infotrieve]
• Dawson I., Keller BP, Brand R., Pesch-Batenburg J., Hajo van Bockel J. Late outcomes of limb loss after failed infrainguinal bypass. J Vasc Surg 1995; 21:613-22.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Antiplatelet Trialists' Collaboration. Collaborative overview of randomized trials of antiplatelet therapy-I: prevention of death, myocardial infarction and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ 1994;308:81-106.[Abstract/Free Full Text]
• Kmietowicz Z. Statins are the new aspirin, Oxford researchers say. BMJ 2001;323:1145.[Free Full Text]
• Menzoian JO, LaMorte WW, Paniszyn CC et al. Symptomatology and anatomic patterns of peripheral vascular disease: differing impact of smoking and diabetes. Ann Vasc Surg 1989;3:224-8.[Medline] [Order article via Infotrieve]
• Schneider PA, Caps MT, Ogawa DY, Hayman ES Intraoperative superficial femoral artery balloon angioplasty and popliteal to distal bypass graft: an option for combined open and endovascular treatment of diabetic gangrene. J Vasc Surg 2001;33:955-62.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Parsons RE, Suggs WD, Lee JJ, Sanchez LA, Lyon RT, Veith FJ Percutaneous transluminal angioplasty for the treatment of limb threatening ischemia: do the results justify an attempt before bypass grafting? J Vasc Surg 1998;28:1066-71.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Golledge J., Ferguson K., Ellis M. et al. Outcome of femoropopliteal angioplasty. Ann Surg 1999;229:146-53.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Bull PG, Mendel H., Hold M., Schlegl A., Denck H. Distal popliteal and tibioperoneal transluminal angioplasty: long-term follow-up. J Vasc Interv Radiol 1992;3:45-53.[Medline] [Order article via Infotrieve]
• Clark TW, Groffsky JL, Soulen MC Predictors of long-term patency after femoropopliteal angioplasty: results from the STAR registry. J Vasc Interv Radiol 2001;12:923-33.[Web of Science][Medline] [Order article via Infotrieve]
• Bolia A., Miles KA, Brennan J., Bell PR Percutaneous transluminal angioplasty of occlusions of the femoral and popliteal arteries by subintimal dissection. Cardiovasc Intervent Radiol 1990;13:357-63.[Web of Science][Medline] [Order article via Infotrieve]
• London NJ, Srinivasan R., Naylor AR, Hartshorne T., Ratliff DA, Bell PR, Bolia A. Subintimal angioplasty of femoropopliteal artery occlusions: the long-term results. Eur J Vasc Surg 1994;8:148-55.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Vraux H., Hammer F., Verhelst R., Goffette P., Vandeleene B. Subintimal angioplasty of tibial vessel occlusions in the treatment of critical limb ischaemia: mid-term results. Eur J Vasc Endovasc Surg 2000;20:441-6.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• McCarthy RJ, Neary W., Roobottom C., Tottle A., Ashley S. Short-term results of femoropopliteal subintimal angioplasty. Br J Surg 2000;87: 1361-5.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Ingle H., Nasim A., Bolia A. et al. Role of subintimal angioplasty of isolated infragenicular vessels in lower limb ischaemia. J Endovasc Therapy (in press).
• Misare BD, Pomposelli FB, Gibbons GW, Campbell DR, Freeman DV, LoGerfo FW Infrapopliteal bypasses to severely, unclampable outflow arteries: two year results. J Vasc Surg 1996;24:6-16.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Verhelst R., Bruneau M., Nicolas AL et al. Popliteal-to-distal bypass grafts for limb salvage. Ann Vasc Surg 1997;11:505-9.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Biancari F., Kantonen I., Alback A., Ihlberg L., Lehtola A., Lepantalo M. Popliteal-to-distal bypass grafts for critical leg ischaemia. J Cardiovasc Surg 2000;41:281-6.[Medline] [Order article via Infotrieve]
• Seeger JM, Coe DA, Harward TRS. The truth about arm veins for infrainguinal bypass. In: Veith FJ (ed.) Current critical problems in vascular surgery. Volume 5. QMP Inc 1993, St Luis (USA).
• Bergan JJ, Veith FJ, Bernhard VM et al. Randomization of autogenous vein and polytetrafluorethylene grafts in femoral-distal reconstruction. Surgery 1982;92:921-30.[Web of Science][Medline] [Order article via Infotrieve]
• Faries PL, Logerfo FW, Arora S. et al. Arm vein conduit is superior to composite prosthetic-autogenous grafts in lower extremity revascularization. J Vasc Surg 2000;31:1119-27.[Web of Science][Medline] [Order article via Infotrieve]
• Raby KE, Goldman L., Creager MA et al. Correlation between preoperative ischemia and major cardiac events after peripheral vascular surgery. N Engl J Med 1989;321:1296-300.[Abstract]
• Mangano DT, Browner WS, Hollenberg M., London MJ, Tubau JF, Tateo IM Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group. N Engl J Med 1990;323:1781-8.[Abstract]
• Rubin JR, Persky J., Lukens MC, Plecha EJ, Graham LM Femoral-tibial bypass for calcific arterial disease. Am J Surg 1989;158:146-50.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Herrera HR, Geary J., Whitehead P., Evangelisti S. Revascularization of the lower extremity with omentum. Clin Plast Surg 1991;18:491-5.[Web of Science][Medline] [Order article via Infotrieve]
• Karp NS, Kasabian AK, Siebert JW, Eidelman Y., Colen S. Microvascular free-flap salvage of the diabetic foot: a 5-year experience. Plast Reconstr Surg 1994;94:834-40.[Web of Science][Medline] [Order article via Infotrieve]
• Vermassen FE, van Landuyt K. Combined vascular reconstruction and free flap transfer in diabetic arterial disease. Diabetes Metab Res Rev 2000;16(suppl 1):S33-6.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]

The British Journal of Diabetes & Vascular Disease, Vol. 2, No. 3, 162-166 (2002)
DOI: 10.1177/14746514020020030301


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This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Torella, F. Articles by Nasim, A. Search for Related Content Social Bookmarking                         What's this?