Trends in the care of the diabetic foot. Expanded role of arterial reconstruction
F. W. LoGerfo, G. W. Gibbons, F. B. Pomposelli Jr, D. R. Campbell, A. Miller, D. V. Freeman and W. C. Quist
Department of Surgery, New England Deaconess Hospital, Harvard Medical School, Boston, Mass.
In recent years, our operative approach to ulceration and gangrene in the
diabetic foot has changed markedly. We now investigate all such patients
for ischemia, even in the presence of neuropathy and localized infection.
This strategy is based on a rejection of the concept of a microvascular
occlusive lesion, an improved understanding of the pattern of
atherosclerotic occlusion, an emphasis on arteriographic delineation of the
foot arteries, and increasing success with extreme distal arterial
reconstruction, especially vein bypass grafts to the dorsalis pedis artery.
From 1984 through 1990, 2883 procedures were performed at our institution
on patients with diabetes mellitus. There was a statistically significant
decrease in every category of amputation, which correlated precisely with
the increasing rate of dorsalis pedis artery bypass. Our indications for
surgery, in-hospital mortality, and the bypass-associated amputation rate
did not change.
Diabetic Foot Complications: Diagnosis and Management
Giurini and Lyons
INT J LOW EXTREM WOUNDS 2005;4:171-182.
ABSTRACT
The Role of Distal Arterial Reconstruction in Patients With Diabetic Foot Ischemia
Lioupis
INT J LOW EXTREM WOUNDS 2005;4:45-49.
ABSTRACT
Geographic Variation of Lower-Extremity Major Amputation in Individuals With and Without Diabetes in the Medicare Population
Wrobel et al.
Diabetes Care 2001;24:860-864.
ABSTRACT
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Foot Ulcers
Sumpio
NEJM 2000;343:787-793.
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Lower Extremity Revascularization in Diabetes: Late Observations
Akbari et al.
Arch Surg 2000;135:452-456.
ABSTRACT
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MR Angiography in the Evaluation of Atherosclerotic Peripheral Vascular Disease
Rofsky and Adelman
Radiology 2000;214:325-338.
ABSTRACT
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Prospective, Randomized Comparison of Ampicillin/Sulbactam and Cefoxitin for Diabetic Foot Infections
Erstad and McIntyre
VASC ENDOVASCULAR SURG 1997;31:419-426.
ABSTRACT
Assessment and Management of Foot Disease in Patients with Diabetes
Caputo et al.
NEJM 1994;331:854-860.
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