Diabetic foot - Vascular diseases

Diabetes, and its complications such as diabetic foot, is a rapidly evolving global pandemic and one of the leading causes of amputation. The total number of diabetic patients worldwide is estimated at 500 million.

The cause of diabetic ulcers is multifactorial. The combination of neuropathy, peripheral arterial disease and infections put the limb at risk, which without proper treatment and management can lead to an amputation.

Diabetic neuropathy causes a loss of sensation in the foot and the plantar aspect, so the patient is sensitive to repeated injuries, which create wounds (ulcers) and are often not noticed. For this reason, it is recommended to check the feet daily for sores. Ulcers usually form at pressure points on the plantar area. Repeated infections of the ulcers and the soft tissues delay their healing, and when they spread to the bones they can cause osteomyelitis.

Peripheral arterial disease coexists in 50% of diabetic patients with ulcers. Evaluation of the arterial system is mandatory. Compared to patients without diabetes, diabetic patients appear to have more advanced arterial disease at initial diagnosis. For this reason, timely examination from a Vascular Surgeon is essential.

Arterial disease in diabetic patients involves the development of extensive calcifications in the arteries of the legs and especially below the knee, causing stenoses and blockages.

The diagnostic approach and the initial treatment of the diabetic foot includes:

  • Imaging to evaluate the bones for possible osteomyelitis (X-ray, MRI)
  • Evaluation of the arterial system with non-invasive methods (duplex, CT/ magnetic angiography)
  • Wound care
  • Avoid pressure on the ulcer sites with suitable shoes
  • Antibiotics in case of infection
  • Diabetes Control

In patients with diabetic ulcers and peripheral arterial disease, revascularization is mandatory. Depending on the findings and the extent of the blockages of the arteries, the type of the procedure is decided by the Vascular Surgeon.

Revascularization procedures can be done with endovascular approach (minimally invasive), with classic open surgery, or with combination of the above (hybrid operations).

Depending on the extent of the blocked arteries, the Vascular Surgeon may decide on open surgery which includes incisions in the leg, “cleaning” the artery from the plaque that causes the narrowing and in some cases creating a bypass.

Endovascular approach, includes the most modern techniques, such as balloons, stents and intravascular lithotripsy, and we have the opportunity to “open” the narrowing and the blockages of the arteries to restore the blood supply to the leg. This is how we achieve the healing of the ulcer minimally invasive with the least possible hospital stay.

Having the ability as Vascular surgeons to perform both types of operations, open and endovascular procedures can be combined (hybrid operations) in the same operating room, depending on the indication, for the best result.

Athens Medical Center, has a hybrid surgery “Prometheus” operating room with state-of-the-art angiographic capabilities. This allows us to perform complex endovascular and hybrid procedures with excellent visualization, improving patient outcomes.

Protect your vessels

Georgios Tzavellas, MD is an expert in the treatment of the diabetic foot, providing the patient with the full spectrum of surgical or non-surgical treatments, offering high quality services and preventing amputations.