| Diabetic foot (DF) in patients with diabetes as a result of the combined nerve lesions and different degree of peripheral vascular disease of the lower limbs caused by infection, ulcer formation and (or) the destruction of deep tissue is a serious chronic complications of diabetes, one of non-traumatic of the main reasons for amputation. According to statistics of the amputation rate of diabetic patients than non-diabetic patients with high 15 times. Symptoms for skin itching, dry without sweat, acral cold, edema, or dry, dark skin color and pigment spots, vellus hair off; acral, burning, numbness, or loss of sensation, foot cotton flu, duck walk away, intermittent claudication, rest pain, difficulty standing squat, often walking stick holders; acral malnutrition, poor muscle atrophy tension, joint ligament injury prone; common metatarsal head subsidence, the formation of metatarsophalangeal joint bending arch foot , hammer-shaped toes, chicken toe, Charcot's joints (Charcot), bone destruction can occur, such as pathological fracture; acral weakening or disappearance of arterial pulse, blood vessels narrow and blood flow Tribunal may hear the noise, slow the disappearance of the depth of reflection. Diagnostic criteria for diabetic foot disease in 1999 in line with the new WHO diagnostic criteria for diabetes; the diagnosis of diabetic foot: a classification scheme Wagner, 0: There are risk factors for foot ulcers, but no ulcer; 1: skin ulcers, non - infection; 2: deeper ulcer, often combined soft-tissue inflammation, no abscesses or bone infections; 3: deep infection, with bone lesions or abscesses; 4: the limitations of gangrene; 5: All foot gangrene; in line with more than one and can be selected. Diabetic foot ulcers and amputations caused by expensive medical care in the United States is almost equivalent to the cost of other medical complications of diabetes the total cost of nuclear, the domestic part of the endocrine specialist general hospital statistics, sufficient patients in the per capita cost of hospitalization million more than to bring about serious social and family burden. Patients are often due to economic factors and other reasons, many patients with vascular disease in diabetes can not accept this kind of treatment early, while the group treated with high-risk patients to choose, so the success rate of surgery is lower than foreign counterparts, reports the long-term patency rate can not be Statistics. However, the clinical study results showed that: PTA surgery to open below-knee occlusion or (and) narrow the blood vessels, can rapidly improve the limb blood supply and reduce high-risk lesions in patients with diabetic limb amputation rate and fatality rate, improve the quality of life is worth promoting treatment one.Objective:Observed from January 2007 to January 2009, a total of 27 cases of diabetes in patients with lower extremity vascular ultrasound and (or) CTA confirmed below-knee vascular stenosis or occlusion Division I live close. L5 cases were male and 12 females, aged 48 ~ 83 years old, the course from 6 to 12 months; the left lower extremity vascular disease in 8 patients, the right side in 12 cases, bilateral in 1 case. Fontain in phases in accordance with: II period (intermittent claudication) 5 cases (19.10%),â…¢period (rest pain) in 7 cases (23.70%), IV period (ulcers and gangrene) 15 cases (57.20%). History of diabetes an average of 12.36 years (5 ~ 35 years). At the same time, 24 cases in which patients with hypertension disease. Ankle-brachial index (ankle brachial index, ABI) 0.36 ~ 0.81, an average of 0.53. 27 cases of patients underwent DSA examination of both lower extremities, 42 were 69 below-knee amputation vascular surgery PTA Bank. PTA selection criteria for preoperative angiography CTA, DSA Intraoperative angiography whether there is outflow tract distal dorsalis pedis or visible to the irregular stenosis of the lower leg distal 1 / 3. The proximal leg 1 / 3 of vascular occlusion and distal outflow tract nor give up the line while the treatment of PTA. Below-knee arteries Percutaneous transluminal angioplasty treatment of diabetic lower limb ischemic disease of short-term efficacy, a preliminary assessment of its clinical value.Mehods:Percutaneous transluminal angioplasty (PTA) treatment of diabetic below- knee vascular lesions of the technical success rate of interventional treatment of diabetic lower limb ischemia in patients with a total of 27 cases of disease, analysis of its clinical symptoms before and after operation to improve the situation, including the Rutherford-Becker points level as well as the ankle-brachial index. Lesions of different types to compare the success rate, and intraoperative analysis of the occurrence of postoperative complications, prevention and treatment methods of preliminary study. The results of 27 cases of patients with clinical symptoms after 26 cases of varying degrees has improved, one cases of lower limb surgery without outflow tract termination. After Rutherfbrd-Becker classification I level in 14 cases. 10 Example II-class, Ill-class Example 3. ABI 0.69 ~ I. 34, an average of 0.98. 42 below-knee amputation in vascular stenosis total of 69 vascular lesions, one of the narrow 47, 22 occlusion. PTA success rate of 82.61% (57 / 69), one of the narrow lesions PTA success rate of 89.36% (42/47), occlusion of sexually transmitted diseases into power for the 68.118% (15/ 22). Intraoperative and postoperative without serious complications in all cases than those in stageâ…¡preoperative increase after 200 meters without discomfort,â…¢period of rest pain within 12 hours were in remission, IV period (ulcer and gangrene) in 12 cases of Example 2 line after amputation, and the remaining patients are recovering. After surgery at 3 months, 6 months in patients with different stages of observation,â…¡patients with no recurrence,â…¢Stage 1 cases in the six months after the emergence of rest pain, IV Phase has two cases of amputation. Stenosing lesions and the opening of occlusive disease results to differ, x2 analysis P <0.01; selection of below-knee Deep dedicated balloon to open the case of lesions by fisher exact probability method x2 test P = 0.05, the difference has statistical significance . And detailed analysis of preoperative, intraoperative and postoperative use of anticoagulant drugs; intraoperative and postoperative complications in the prevention and treatment; and to sum up the characteristics of all cases, summed up the choice of indications, intraoperative points Notices .Results:A total of 27 cases of patients with 26 cases of postoperative improvement of symptoms in varying degrees, one cases of outflow tract to give up without surgery. After Rutherfbrd-Becker classification I level in 14 cases. II level of 10 cases, Ill grade 3 cases. ABI 0.69 ~ I. 34, an average of 0.98. 42 in below-knee vascular stenosis total of 69 vascular lesions, including 47 narrow, 22 occlusion (Table 1). PTA success rate of 82.61% (57/69), in which narrow lesions the success rate of PTA for the 89.36% (42/47), occlusion of sexually transmitted diseases into power 68.118% (15/22). Intraoperative, after no serious complications in all cases than those in stageâ…¡patients after an increase of 200 meters without discomfort,â…¢period of rest pain within 12 hours are in remission, IV period (ulcers and gangrene) 12 cases 2 cases line after amputation, and the remaining patients are recovering. After surgery at 3 months, 6 months in patients with different stages of observation,â…¡patients with no recurrence,â…¢1 cases in the six months period after the rest pain, IV period of two cases of amputation. There are 27 cases of patients with surgery in 1 case of acute thrombosis, for early cases. After intra-arterial urokinase as improved blood vessel open, no serious complications; one cases of patients with vascular guide wire perforation, contrast extravasation of contrast agent was found, according to the speed of contrast agent leaking, seepage is not the volume of the suspension of operations, continue to open other blood vessels, 1h contrast again to stop the bleeding.Conclusion:This group a relatively small number of cases, especially for surgery, postoperative complications, cases still need to be large observational study, PTA after treatment need to be further long-term effect of the follow-up evaluation; of this study show that, PTA instant The success rate with the CLI of the lesion type, lesion stenosis greater than the success rate of occlusive disease, so that there are symptoms of peripheral vascular ischemia in diabetic patients, PTA should be the treatment of early and avoid the development of occlusive disease into; by angioplasty in the treatment of diabetic lower limb ischemic disease of the ideal choice for patients with preoperative lower extremity arterial careful assessment of the situation, formulate a reasonable program of surgery, critical to the success of the surgery; Percutaneous transluminal angioplasty treatment of diabetic below-knee The results show that vascular lesions have the safety and good clinical results, can quickly improve the limb blood supply and reduce high-risk lesions in patients with diabetic limb amputation rate and fatality rate, improve the quality of life and should be recommended in the treatment of peripheral arterial disease in diabetic patients, especially the lower extremities ischemic disease of choice.
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