Lower-extremity arterial revascularization: Is there any evidence for diabetic foot ulcer-healing? - 11/06/15

Doi : 10.1016/j.diabet.2015.05.004

J. Vouillarmet ^a,^⁎,^{^{1
These authors equally contributed to this work.}} , O. Bourron ^b,^c,^d,^e,^{^{1
These authors equally contributed to this work.}}, J. Gaudric ^f, P. Lermusiaux ^g,^h, A. Millon ^g,^h, A. Hartemann ^b,^c,^d,^e
^a Department of endocrinology, diabetes and nutrition, hospices civils de Lyon, centre hospitalier Lyon sud, 69495 Pierre-Bénite, France
^b Department of endocrinology, nutrition, and diabetes, AP–HP, 75013 Paris, France
^c Sorbonne universités, 75005 Paris, France
^d Inserm UMR_S 1138, centre de recherche des Cordeliers, 75005 Paris, France
^e Institute of cardiometabolism and nutrition, 75013 Paris, France
^f Department of vascular surgery, AP–HP, 75013 Paris, France
^g Department of vascular surgery, hospices civils de Lyon, 69003 Lyon, France
^h Université Claude-Bernard Lyon 1, 69100 Lyon, France

^⁎Corresponding author. Service d’endocrinologie, diabète et nutrition, pavillon médical, centre hospitalier Lyon sud, 69310 Pierre-Bénite, France. Tel.: +33 4 78 86 44 48; fax: +33 4 78 86 12 75.

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Thursday 11 June 2015
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Abstract

The presence of peripheral arterial disease (PAD) is an important consideration in the management of diabetic foot ulcers. Indeed, arteriopathy is a major factor in delayed healing and the increased risk of amputation. Revascularization is commonly performed in patients with critical limb ischaemia (CLI) and diabetic foot ulcer (DFU), but also in patients with less severe arteriopathy. The ulcer-healing rate obtained after revascularization ranges from 46% to 91% at 1 year and appears to be improved compared to patients without revascularization. However, in those studies, healing was often a secondary criterion, and there was no description of the initial wound or its management. Furthermore, specific alterations associated with diabetes, such as microcirculation disorders, abnormal angiogenesis and glycation of proteins, can alter healing and the benefits of revascularization. In this review, critical assessment of data from the literature was performed on the relationship between PAD, revascularization and healing of DFUs. Also, the impact of diabetes on the effectiveness of revascularization was analyzed and potential new therapeutic targets described.

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Keywords : Arterial, Diabetes, Healing, Revascularization, Ulcer