| Peripheral arterial disease in diabetic patients with renal insufficiency: a review. | |
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MedLine Citation:
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PMID: 22271722 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Peripheral arterial disease is common among diabetic patients with renal insufficiency, and most of the diabetic patients with end-stage renal disease (ESRD) have peripheral arterial disease. Ischaemia is probably overrepresented as an etiological factor for a diabetic foot ulcer in this group of patients compared with other diabetic patients. ESRD is a strong risk factor for both ulceration and amputation in diabetic patients. It increases the risk of nonhealing of ulcers and major amputation with an OR of 2.5-3. Renal disease is a more important predictor of poor outcome after revascularizations than commonly expected. Preoperative vascular imaging is also affected by a number of limitations, mostly related to side effects of contrast agents poorly eliminated because of kidney dysfunction. Patients with renal failure have high perioperative morbidity and mortality. Persistent ischaemia, extensive infection, forefoot and heel gangrene, poor run-off, poor cardiac function, and the length of dialysis-dependent renal failure all affect the outcome adversely. Despite dismal overall outcome, recent data indicate that by proper selection, favourable results can be obtained even in ESRD patients, with the majority of studies reporting 1-year limb salvage rates of 65-75% after revascularization among survivors. High 1-year mortality of 38% reported in a recent review has to be taken into consideration, though. The preferential use of endovascular-first approach is attractive in this vulnerable multimorbid group of patients, but the evidence for endovascular treatment is very scarce. The need for complete revascularization of the foot may be even more important than in other patients with ischaemic ulcerated diabetic foot because there are a number of factors counteracting healing in these patients. Typically, half of the patients are reported to lose their legs despite open bypass. To control tissue damage and improve chances of ulcer healing, one should understand that early referral to vascular consultation is necessary. Copyright © 2012 John Wiley & Sons, Ltd. |
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Authors:
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Mauri Lepäntalo; Leslie Fiengo; Fausto Biancari |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Diabetes/metabolism research and reviews Volume: 28 Suppl 1 ISSN: 1520-7560 ISO Abbreviation: Diabetes Metab. Res. Rev. Publication Date: 2012 Feb |
Date Detail:
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Created Date: 2012-01-24 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100883450 Medline TA: Diabetes Metab Res Rev Country: England |
Other Details:
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Languages: eng Pagination: 40-5 Citation Subset: IM |
Copyright Information:
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Copyright © 2012 John Wiley & Sons, Ltd. |
Affiliation:
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Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland. mauri.lepantalo@hus.fi. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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