Peut-on prévenir les amputations majeures chez les diabétiques neuropathiques ?

Abstract

Aim of the study: To show the possibility of avoiding and even
prevent major amputations by bypass
ankle arterialization in diabetics
neuropathic with persistent ankle pulse and
Recurrent necrotic lesions of the forefoot.
Materials and Methods: Ten diabetics, 9 men and
1 woman with distal necrotic lesions despite
the presence of a pulse at the ankle, were arterialized between
January 2007 and October 2009. There were 9 men and 1
female, average age of 55 years and 9 months, (range:
46-62 years) 2 had chronic edema of the foot and
leg, eight toe necrosis, 1 puncture pain
plantar and another a big toe ulcer. The evaluation
pulse rate was decisive in the decision to
arterialization. The pulse was cross-scored from 0 to 4+.
Five had 1 pulse and the other 5 had both pulses
palpable at the instep. The Doppler examination was by
against further examination. All patients
had an ankle-arm systolic pressure index (IPS)
within normal limits. All have benefited from a
arteriography including the foot. They were treated by
a bypass at the ankle between an artery with good flow and the
internal marginal vein of the foot.
Results: Out of the 10 arterializations there was 1 follow-up failure
of a leg amputation and 9 successes with an average follow-up
17 months old. Seven bypass grafts were thrombosed after 6 months
on average and 2 are still permeable. Two recurrences:
one 2 years and 5 months after his operation and the other after 5
month. No death, no major amputation, no
cardiac overload or varicose veins are not to be deplored.
Conclusions: These results argue in favor of
arterialization as a means of avoiding where even
prevent major amputations in diabetics
neuropathic. A greater number of patients with a
longer follow-up is necessary for these conclusions
are final.