I. Overview
Diabetes is the third largest non-communicable disease in developed countries after cardiovascular disease and tumor. the WHO reported in 1997 that there are about 135 million people with diabetes worldwide, and it is predicted that the number will rise to 300 million in 2025. With the improvement of our people’s living standards, the incidence of diabetes in China is also increasing, according to statistics, the incidence of diabetes in the age of 20-70 years is as high as 3.2%, so diabetes has also become a serious health hazard of our people’s common diseases, multi-morbidity.
If diabetes is not treated correctly and in a timely manner, many serious complications may occur, which may even involve all organs of the body, such as the brain, kidneys, heart and peripheral blood vessels. Diabetic foot is a complication that seriously affects the life and health of diabetic patients after they do not receive timely and proper treatment for diabetes. The main reason is that the arteries in the lower limbs are damaged after diabetes, resulting in insufficient blood supply to the arteries in the lower limbs, plus peripheral neuropathy and bacterial infection, resulting in foot pain, deep skin ulcers, gangrene of the extremities and other lesions, collectively known as diabetic foot.
Second, clinical manifestations
In the early stage of diabetic foot patients, the main manifestations are coldness of the affected limb, numbness, intermittent claudication, pain and swelling of the lower leg and muscle atrophy and other lower limb ischemic manifestations. With the aggravation of the disease, the above-mentioned symptoms aggravate, and at the same time there will be resting pain, that is, in a quiet state toes, feet or calves will also appear persistent pain, more intense at night or in cold conditions, patients often sit with their feet and stay up all night, indicating that the patient’s lower limb ischemia aggravates, and the blood vessels are even completely occluded. At this time, examination of the affected foot will reveal pallor, cyanosis, ecchymosis, coldness, and even gangrene or ulcer infection at the extremity, and in severe cases, systemic toxic symptoms. The pulsation of femoral artery, N artery and dorsalis pedis artery of the affected limb is weakened or disappeared.
III. Diagnosis
Based on the patient’s history, physical examination, laboratory tests, and vascular ultrasound, the diagnosis of diabetic foot is not difficult. However, many patients often know they have diabetes only after complications have appeared, so it is essential for those who have the conditions to have regular checkups. If complications arise it is also important to first control the blood sugar and actively treat the complications at the same time. Otherwise, it can lead to very serious consequences and even endanger the patient’s life.
IV. Treatment
In the past, the amputation rate of diabetic foot patients was as high as about 10%, and because most of the patients with “diabetic foot” are older, the trauma surface is large after surgery, and the wound is difficult to heal, so it is easy to get infected and recur. After amputation, the mortality rate is as high as 50% within two years. With the development of modern interventional technology, revolutionary progress has been made in the treatment of diabetic foot, which is described as follows.
First of all, it must be kept in mind that the treatment of diabetic foot should be a comprehensive treatment process.
1. Treatment of diabetes itself.
Blood glucose is controlled through medication and diet and other treatments, and currently blood glucose levels can be relatively well controlled through these treatments.
2, rapid restoration of blood supply to the lower limbs is the key to the treatment of diabetic foot.
In the past, pharmacological treatment, whether it is Chinese medicine or western medicine, has good effect on early mild lower limb ischemia, but for patients whose blood vessels have been significantly narrowed and whose lower limb ischemia symptoms are more serious, the effect of simple pharmacological treatment is poor, and even the best treatment time will be delayed because of its slow action. Interventional treatment is very effective in restoring blood supply in both early and late stages. At present, interventional treatment mainly includes endovascular thrombolysis, balloon dilatation and angioplasty, stent implantation, thrombus spin aspiration, intraluminal vascular ultrasound ablation, thrombus plaque removal, etc.
(1) Endovascular thrombolysis: Thrombolytic catheter is inserted directly into the thrombus and thrombolytic drugs are used for thrombolysis, which is effective for early occlusion due to thrombus formation, but less effective for old thrombus.
(2) Balloon dilation and shaping: It has good effect on the stenosis caused by atheromatous plaque or old thrombus, now Italy and the United States have developed long balloons up to 20 centimeters long and only 2 millimeters in diameter, which have better compliance and better dilation and shaping effect than the previous short balloons, especially for the longer lesions, it can shorten the operation time. The current clinical application has achieved good results.
(3) Stent implantation: For lesions with stenosis after balloon dilatation, stenting can be considered for treatment. Therefore, it is better not to use stents in vessels below the knee.
(4) Endoluminal ultrasound ablation: low-frequency high-energy ultrasound is used to crush thrombus and plaque, which is more effective for fresh thrombus, but still difficult for old plaque, and the catheter cost is higher.
(5) Thrombus rotary aspiration: The thrombus is aspirated into the catheter by using a high-speed rotating cut-and-suction catheter, which is more effective for fresh thrombus, but less effective for old plaque, and the catheter cost is also higher, and it is only suitable for thrombus of large vessels, but not for thrombus of vessels below the knee, because the catheter is thicker.
(6) Thrombosed plaque resection: the plaque is resected by using resection catheter with blade, the condition is that the guidewire can pass through the true lumen of the blood vessel, otherwise it will damage the blood vessel, the catheter cost is also higher, but it can solve the stenosis of small blood vessels of 2mm lower limbs.
3. Rehabilitation treatment after restoration of blood supply.
After the blood vessel is opened, the follow-up rehabilitation treatment is also very important, because the damage to the blood vessels of diabetic foot can involve the tiny blood vessels, so after opening the main blood vessels, the follow-up treatment should also be carried out. In addition, if a stent is used, follow-up treatment such as anticoagulation is also required. If the vessel has been occluded for too long, reperfusion injury can occur after opening the vessel, and early prevention and treatment are also needed. These treatments mainly include: vasodilatation, anticoagulation, thrombolysis, improvement of microcirculation, blood-vitalizing herbs, antioxidants, anti-infection and other treatments.
To sum up: diabetic foot should be treated early, and its treatment should be a comprehensive treatment mainly based on interventional therapy. Simple herbal or western medicine treatment has certain limitations and may delay the timing of treatment. The specific choice of interventional treatment should be decided by the interventional specialist according to the patient’s condition, including the economic situation. At present, through interventional treatment, the amputation rate of diabetic foot patients has been reduced to almost zero, and all patients have achieved very satisfactory results.