Vascular surgery is an emerging, cross-cutting and cutting-edge discipline, which has a history of more than 20 years of development in China. Jinan Central Hospital affiliated to Shanda University is a tertiary level A hospital that carries out research and clinical study of this specialty at an early stage in China. Under the leadership of Professor Meng Qingyi, the director of the Vascular Surgery Department of Jinan Central Hospital, in addition to completing many high-quality and difficult major surgeries with their strong technical strength and rich clinical experience, they also continue to study and innovate around the discipline, and have made remarkable development achievements, always walking At the forefront of vascular surgery in China, they are trusted by patients for their accurate diagnosis, fine and skillful surgical techniques, and high success rate. Diabetic foot, a serious complication of diabetes, is the result of a combination of lower limb vasculopathy, neuropathy and infection, and patients often experience numbness, swelling, pain, ulceration and even gangrene of the foot. It is a general term for foot pain, deep skin ulcers, and gangrene of the extremities caused by a combination of diabetic factors. The traditional treatment for diabetic foot is amputation, which not only affects the patient’s quality of life, but also adds a burden to the society and the patient’s family, and most patients and their families are unwilling to accept it. With the development of science and technology, a new type of balloon and guidewire suitable for the blood vessels of the lower leg was born internationally, making the interventional treatment of peripheral vascular diseases such as diabetic foot a reality. However, due to technical conditions and other reasons, there are still relatively few hospitals in China that are capable of clinically carrying out this technology. Meng Qingyi, director of vascular surgery at Jinan Central Hospital, is an early expert in this new technology in China, and has been very mature in treating diabetic foot and lower limb atherosclerotic occlusive disease with this technology for three years of exploration, and has achieved better results. For this reason, the reporter interviewed Meng Qingyi, director of vascular surgery at Jinan Central Hospital. Four major symptoms to draw your attention Diabetes is one of the top three killers of modern chronic diseases. The most frightening thing about diabetes itself is actually its complications, of which the diabetic foot is one of the more serious diabetic complications and the main cause of disability in diabetic patients. According to Director Meng, the incidence of diabetic foot is quite high, and the chance of gangrene is also much higher than normal. Due to the long-term high sugar state and some other factors, such as obesity, hyperlipidemia, hypertension, smoking, etc., resulting in lesions of the body’s large and small blood vessels, nerves, tendons, fascia and other tissues, tissue metabolic disorders in the foot, circulation, nutritional disorders, dullness or loss of sensation, easy injury or bacterial, mycotic and other infections, the formation of diabetic foot gangrene. This is the main reason why diabetic patients’ feet are prone to breakage and gangrene. Director Meng reminded diabetic patients that four major symptoms must be brought to your attention: first, feeling cold, numbness in the lower limbs, leg muscle spasms, or cramps, as we say, this symptom is often mistaken for calcium deficiency and ignored by the elderly; second, pain after exercise, such as walking a distance to produce spasmodic pain, had to rest for a while, and then walk a distance after the pain reappears, pain in the calf The pain appears in the calf, followed by the buttocks, thighs, back, feet and other parts; third, the skin color changes, especially pain occurs at night, after the limbs hang low or slight activity, the pain is reduced, may have occurred more serious vascular lesions, should promptly seek medical attention, otherwise further development will enter the necrotic phase; fourth, tissue ischemia necrosis, common skin dystrophy muscle atrophy, coarse skin, sweat hair is scarce or fall off; toe (finger) nail Slow growth, thickening, less luster, the foot has a slight rupture is not easy to heal, the condition is serious, there will be blackening of the limb infection necrosis. Diabetic foot lesions are the result of a complex interaction between many factors, including peripheral neuropathy (including autonomic neuropathy), macrovascular disease, and poor foot hygiene. The magnitude of the role played by each factor varies from person to person and is one of the most dreaded diabetic complications due to its consequence of leading to lower limb amputation. The chance of lower limb amputation is 15-40 times higher in diabetics compared to the general population. The risk is higher in the elderly. However, most amputations can be avoided if managed aggressively. Minimally invasive intervention opens up a new way to treat diabetic foot According to Director Meng Qingyi, the onset of diabetic foot is due to the accumulation of numerous lipid plaques of different sizes on the inner wall of blood vessels, which makes the lumen of blood vessels thinner and the blood flow through less, and the end of the limb, especially the toe or calf, develops metabolic disorders due to the lack of blood supply and gradually degenerates and necroses, which is traditionally one of the difficult clinical diseases. Traditional treatment is mostly conservative in internal medicine, and surgical amputation is often required for patients with advanced disease, which brings great mental and physical pain to patients. With the continuous advancement of medical research, especially the rapid development of interventional technology in recent years, breakthroughs have been made in the treatment of this intractable disease. The basic principle is to use a minimally invasive technique of percutaneous puncture to send a special tiny balloon into the narrowed or occluded diseased blood vessel under the guidance of a special guidewire to explore, unblock and repeatedly expand the diseased blood vessel segment by segment, so as to reopen the diseased blood vessel, restore blood flow and improve the blood supply to the distal limb. distal blood supply. Simply put, a puncture is made at the root of the thigh, and from this puncture point, a hair-thin, special-out guide wire and catheter are introduced. The guide wire is inserted along the femoral artery under the monitoring of imaging equipment to penetrate deep into the diseased vessel that has been narrowed or even blocked, and then a contrast agent is used to fully dilate the balloon, hold open the diseased tissue, and dilate the definitive diseased vessel, thereby restoring normal blood flow. This treatment applies local anesthesia, and during the procedure, the patient is awake, and the side effects of local anesthesia are relatively small compared to other anesthesia methods. Therefore, the intervention is not only suitable for patients in good health, but also for patients who are old, frail, or have combined diseases of other organs. This treatment method has the outstanding advantages of small trauma, quick effect and high limb preservation rate, which opens up a new way for the treatment of diabetic foot. According to Director Meng, diabetic foot vascular lesions are characterized by a wide range of lesions involving several arteries bilaterally and a multinodal distribution, making surgical procedures such as bypass surgery difficult to deal with larger lesions, while interventional treatment is more suitable for patients. In general, suitable percutaneous endovascular thrombolysis, endovascular balloon angioplasty, endovascular stent implantation, laser angioplasty, atheromatous plaque cutting, lower extremity brachytherapy, and percutaneous mechanical thrombectomy are feasible to maintain the patency of blood vessels and achieve the treatment purpose fundamentally. Interventional methods for treating diabetic foot can solve the lower limb vascular lesions caused by diabetes from the etiology, rapidly restore the blood supply, create a basis for solving neuropathy, treating infection and healing ulcers, thus completely getting rid of the powerless situation of traditional treatment. At present, through minimally invasive interventional treatment, the vascular surgery specialty of Jinan Central Hospital can open up the small vessels in the entire lower limb, including the most distal plantar, so that the blood flow in the lower limb is completely unobstructed from top to bottom. The limb preservation rate is much higher than before, bringing a boon to patients with advanced diabetic foot. According to Director Meng, in addition to diabetic foot, peripheral vascular lesions such as stenosis of iliac artery, femoral artery, renal artery and lower limb artery caused by atherosclerosis can also be treated satisfactorily through interventional therapy. Diabetic foot prevention is better than cure According to Director Meng, it is necessary for diabetic patients to take some preventive measures to avoid complications of diabetic foot, especially the following points must be noted: Eat less greasy and sugary food. Strictly controlling blood sugar and avoiding high blood sugar is a very important part of preventing and treating diabetic foot, which can prevent and delay the occurrence of diabetic complications. Prohibit smoking and do more gentle exercises to improve microcirculation. To promote blood circulation in the feet you can do more exercises, preferably gentle ones, such as walking or leg exercises. Proper exercise can improve microcirculation, promote metabolism, improve the body’s sensitivity to insulin, increase the use of glucose by muscles and tissues, and achieve the purpose of preventing diabetic foot. Active prevention of foot trauma is the most fundamental way to prevent the occurrence of foot ulcers, and diabetic patients must pay attention to prevent any minor injuries to the feet. Do not walk barefoot to prevent puncture injuries; do not wear shoes and socks that do not fit the foot, which should be soft and comfortable and breathable. Do not use hot water to soak your feet; soak your feet in warm water for 10 to 15 minutes every day, and pay attention to the temperature and time when using hot water bags or foot physiotherapy. Do not over-trim toenails. Do not neglect tinea pedis infections and treat tinea pedis nail infections promptly. In case of foot injury, early treatment is the key to avoid amputation. Maintaining the integrity and cleanliness of the foot skin is also a key point to protect diabetic patients from diabetic foot. Diabetic patients should check the soles of their feet every night before going to bed. If elderly people have difficulty bending their feet to see the soles of their feet due to physical reasons, they can place a mirror in front of their feet and observe the situation of their feet reflected in the mirror. Go to the hospital for medical treatment, do not dispose of yourself. Any problem of diabetic feet should be cautious, otherwise the consequences are serious. Finally, Director Meng reminded that once a diabetic patient shows symptoms such as weakness of the lower limbs and a significant weakening of the arterial pulsation in the back of the foot, at least 70% of the blood vessels in the lower limbs have been stenosed; when there is pain, numbness, soreness and other symptoms, the stenosis is even worse; when there is a foot rupture, it will face the consequences of amputation. Therefore, diabetic patients should pay close attention to their lower extremities, especially their feet, while adhering to reasonable medication to control their condition, and the earlier they receive interventional treatment, the better.