Diabetic Foot / PAD Stenting

Diabetic vascular disease refers to the development of blockages in the arteries, sometimes called “hardening of the arteries”, throughout the body because of diabetes. If you have diabetes, it means that too much glucose (blood sugar) is in your bloodstream because of your body’s inability to either produce insulin or to use insulin efficiently. Insulin is a hormone that you need to transport glucose from the bloodstream into your cells where it is used to produce energy.

You may also develop several vascular diseases that have been linked to diabetes. One of these is retinopathy, which is the abnormal growth of blood vessels in your retina, which is part of your eye. Another condition linked to diabetes is a kidney disease called nephropathy. If you have diabetes, you are also more prone to hardening of the arteries, high cholesterol, high blood pressure, and coronary heart disease. You may also develop neuropathy, a condition of the nerves themselves that causes a loss of protective sensation in the toes or feet.

Controlling your blood sugar is the best way to slow or prevent these vascular problems. If you do not manage your diabetes or maintain healthy habits, you could develop serious health conditions, including blindness, severe kidney disease, stroke, heart attack, or sores in your feet. Eventually, if you develop dead tissue, which is known as gangrene, it could lead to infection and ultimately to amputation.

If you have diabetes-related vascular problems, you may have the following symptoms:

  • Blurry vision
  • Floating spots in your vision called floaters
  • Swelling of your face or limbs or unexpected weight gain
  • Foamy looking urine
  • Foot sores
  • Loss of feeling or a burning feeling in your hands or feet
  • Pain in your legs when walking
  • High blood pressure
  • Chest pain

If you have diabetes, it may increase the chances for the development of several vascular diseases. Your risk of vascular disease increases with the length of time you have had diabetes. You also increase your risk of developing diabetic vascular disease if you have high blood pressure, if you smoke, don’t exercise, are overweight, or eat a high-fat diet.

PAD treatment
When peripheral arterial disease (PAD) causes sores to develop on your feet, your physician will use dressings and sometimes antibiotics to help heal the sores before they become too extensive or deep. He or she will determine if enough blood is reaching the sores to allow them to heal. It is important to treat the sores promptly because if the sores become so bad that the tissue of your foot dies, or the deep tissues or bones become infected, your surgeon may need to partially or completely amputate your foot or leg. To restore circulation to your leg and avoid amputation, your surgeon may need to perform a procedure such as angioplasty

In an angioplasty, a long, thin, flexible tube called a catheter is inserted through a puncture, or sometimes through a tiny incision, into an artery in your leg above the narrowed section and is guided through your arteries to the blocked area. Once there, a special balloon attached to the catheter is inflated and deflated, sometimes several times. The balloon pushes the plaque in your artery against your artery walls, widening the vessel. If needed, a tiny mesh-metal tube called a stent may then be placed into the narrowed area of your artery to keep it open. The stent remains permanently in your artery. After successful angioplasty, blood flows more freely through your artery. Your general health, as well as the location and extent of the blockage, determine what procedure is likely to work best in your particular situation.

There are many lifestyle changes that you can make to improve your health and stay healthy. They include quitting smoking, eating a low-fat diet, maintaining a healthy weight, and exercising regularly. You should also monitor your blood glucose level several times per day, as directed by your physician. To prevent foot sores, you should examine your feet daily. If you have a tendency toward dry skin, use a lanolin-based moisturizing cream to prevent callus buildup and cracking. Always protect your feet from injury and keep them dry.

Peripheral Arterial Disease (PAD) common in DIABETIC patients / DIABETIC FOOT

Peripheral arterial disease (PAD), also known as peripheral vascular disease (PVD), is a very common condition affecting people of age 65 and older. PAD develops most commonly as a result of atherosclerosis, or hardening of the arteries, which occurs when cholesterol and scar tissue build up, forming a substance called plaque inside the arteries. This is a very serious condition. The clogged arteries cause decreased blood flow to the legs, which can result in pain when walking, and eventually gangrene and amputation.

Because atherosclerosis is a systemic disease (that is, affects the body as a whole), individuals with PAD are likely to have blocked arteries in other areas of the body. Thus, those with PAD are at increased risk for heart disease, aortic aneurysms and stroke. PAD is also a marker for diabetes, hypertension and other conditions.

PAD may also be caused by blood clots.

  • The most common symptom of PAD is called intermittent claudication, which is painful cramping in the leg or hip that occurs when walking or exercising and typically disappears when the person stops the activity.
  • Numbness, tingling and weakness in the lower legs and feet
  • Burning or aching pain in feet or toes when resting
  • Sore on leg or foot that won’t heal
  • Cold legs or feet
  • Color change in skin of legs or feet
  • Loss of hair no legs
  • Have pain in the legs or feet that awakens you at night

Many people simply live with their pain, assuming it is a normal part of aging, rather than reporting it to their doctor.

  • PAD can happen to anyone, regardless of age, and is most commonly seen in men and women over age 50.
  • And most common in diabetics

Those who are at highest risk for PAD are

  • Over age 50
  • Smokers
  • Diabetic
  • Overweight
  • Inactive (and do not exercise)
  • Have high blood pressure or high cholesterol or high lipid blood test
  • Have a family history of vascular disease, such as PAD, aneurysm, heart attack or stroke
  • Diagnosed by colour Doppler scan of the lower limb arterial system.
  • CT angiogram and DSA angiogram are done accordingly to diagnose, confirm and plan the angioplasty and stenting.
  • Angioplasty and stenting: Interventional radiologists pioneered angioplasty and stenting, which was first performed to treat peripheral arterial disease. Using imaging for guidance, the interventional radiologist threads a catheter through the femoral artery in the groin, to the blocked artery in the legs. Then the interventional radiologist inflates a balloon to open the blood vessel where it is narrowed or blocked. In some cases this is then held open with a stent, a tiny metal cylinder. This is a minimally invasive treatment that does not require surgery, just a nick in the skin the size of a pencil tip. Balloon angioplasty and stenting have generally replaced invasive surgery as the first-line treatment for PAD. Early randomized trials have shown interventional therapy to be as effective as surgery for many arterial occlusions, and in the past years, a very large clinical experience in centers throughout the world has shown that stenting and angioplasty are preferred as a first-line treatment for more and more processes throughout the body.
  • Atherectomy: With this treatment, a tiny catheter is inserted into the artery at the site of blockage that is able to “shave” or “cut” the plaque from the inside of the artery and remove it from the patient.
  • Stent-grafts: A stent covered with synthetic fabric is inserted into the blood vessels to bypass diseased arteries.