Syed Muhammad Azeem* and Omer Ehsan
Department of Vascular Surgery, Shifa International Hospital, PakistanFulltext PDF
In developing country such as Pakistan the number of diabetic patients is increasing due to sedentary life style, obesity, urbanization and complications of diabetes like Diabetic Foot Ulcer (DFU) are also on a rise. Pakistan is ranked seven in the world of having largest population of diabetes in Pakistan with prevalence of 7.6% to 11% in adults 34, 35. The prevalence of PAD in Pakistani diabetic patients is 31.6% with amputation risk of 16% which is a significant number of cases that should be diagnosed and treated early for limb salvage 36, 37. A vascular surgery service in Pakistan is deficient with only handful of qualified surgeons and trainers. Till date there is no study on the ischemic complications of diabetic foot in Pakistan and their treatment outcomes. We present our data of 388 patients treated in our hospital with ischemic diabetic foot ulcer.
Objective: To describe the outcome of patients treated for diabetic foot with multidisciplinary approach in a tertiary care unit and to determine limb salvage rate in those patients having ischemic complications of diabetic foot.
Methodology: A retrospective study conducted in a tertiary care hospital, from January 2015 to June 2020. Data was collected using electronic medical record in SIH. Inclusion criteria were diabetic patients >18 years old with foot ulcer while, those less than 18 years, and having autoimmune disease were excluded from the study. Three hundred and eighty-eight diabetics (type 1 & type 2) were included in the study. The data was collected and analyzed in SPSS 23. P value of <0.05 was considered significant.
Results: Out of total 1,127 patients analyzed only 388 patients were included in our study. 195 of these patients had mild PAD (Peripheral arterial disease) who were treated with daily dressing and debridement only. Remaining 193 patients had significant PAD. 97 of these patients underwent angioplasty and 96 underwent surgical bypass. 16 patients underwent angioplasty and stenting of iliac vessels. Superficial femoral artery angioplasty was performed in 13 patients and below-knee balloon angioplasty was performed in 55 cases without use of stents. Good 1-year patency rates were achieved in proximal lesions 82% as compared to distal lesions 66%. Femoral to popliteal bypass was performed in 71 patients and femoral to distal bypass in 25 patients. Limb salvage rate in the angioplasty group was 85% while in the surgical bypass group was 96% after 01 year follow up.
Conclusion: Good patency and limb salvage rates can be achieved with early detection and treatment of ischemic diabetic foot. We need large randomized control trials to search for the best available treatment options for diabetic patients in Pakistan.
Diabetes mellitus; Foot ulceration; Amputation; Angioplasty; Revascularization; Diabetic ischemic foot; Ischemia
Azeem SM, Ehsan O. Experience of Diabetic Foot Management and Frequency of Limb Salvage at a Tertiary Care Hospital in Pakistan. World J Vasc Surg. 2020; 3(1): 1023..