Peripheral Interventions in Non Healing Diabetic Foot Ulcer
Peripheral interventions play a crucial role in managing non-healing diabetic foot ulcers, particularly when poor blood circulation due to Peripheral Artery Disease (PAD) is a contributing factor. Restoring adequate blood flow is essential for effective wound healing, infection control, and preventing severe complications such as limb amputation.
Coronary angiography and angioplasty
Renal Angioplasty
Coronary Angiography
Left Main Angioplasty
Pre-Procedure Assessment
Calcified Arteries
Pacemaker Implantation
Valvular Heart Disease
Endovascular Graft Repair
Device Closures
Peripheral Interventions
Renal Angioplasty
Non Invasive Cardiology
Understanding the Problem
Diabetic Foot Ulcers (DFUs)
DFUs are chronic, non-healing wounds that typically develop on the feet of diabetic patients.
Causes: Neuropathy (nerve damage), poor circulation, foot deformities, or repeated pressure and trauma.
Delayed Healing Factors: Infections, inadequate blood flow, high blood sugar levels, and improper wound care.
Peripheral Artery Disease (PAD)
PAD occurs when arteries supplying the legs and feet become narrowed due to plaque buildup, reducing oxygen and nutrient delivery to tissues.
Symptoms: Leg pain during walking (claudication), numbness, cold or discolored feet, and slow-healing wounds.
PAD is a major cause of non-healing foot ulcers and limb ischemia in diabetic patients.
Peripheral Interventions
Restoring blood flow through revascularization is the cornerstone of managing ischemic diabetic foot ulcers. The main interventions include:
Angioplasty and Stenting
Purpose: To open narrowed or blocked peripheral arteries, improving blood flow to the affected limb.
Procedure:
A catheter with a small balloon is guided into the blocked artery.
The balloon is inflated to widen the artery.
A stent (small metal mesh tube) may be placed to keep the artery open.
Indication: Ideal for patients with PAD causing reduced foot perfusion and non-healing ulcers.
Benefits: Minimally invasive, shorter recovery time, and improved ulcer healing rates.
Endarterectomy
Purpose: Surgical removal of plaque buildup inside the artery.
Procedure:
The artery is opened surgically, and the atherosclerotic plaque is removed.
The artery is then closed to restore normal blood flow.
Indication: When localized plaque removal is feasible and angioplasty or stenting is not suitable.
Outcome: Immediate restoration of blood flow and improved oxygen supply to the foot.
Bypass Surgery
Purpose: To create an alternate route for blood to flow around a blocked artery.
Procedure:
A graft (a vein from the patient or synthetic tube) is connected to bypass the blocked section.
Indication: For severe PAD cases where other endovascular methods are not effective.
Benefits: Significant improvement in circulation, promoting healing and preventing amputation.
Comprehensive Management Approach
Wound Care: Regular cleaning, debridement (removal of dead tissue), and dressings to promote healing.
Infection Control: Antibiotic therapy if infection is present.
Glycemic Control: Maintaining optimal blood sugar levels to enhance healing.
Offloading: Reducing pressure on the ulcer using specialized footwear or orthotic devices.
Lifestyle Modifications: Smoking cessation, balanced diet, and regular exercise to support vascular health.
Outcome and Benefits
Improve blood flow and tissue oxygenation
Promote ulcer healing and pain relief
Prevent major amputations
Enhance mobility and quality of life
