Diabetes, which is one of the important health problems all over the world and in our country, can progress insidiously and cause damage to all systems of our body. One of the most important complications of diabetes is the serious wounds on the feet and the resulting infections. Acıbadem University Atakent Hospital Cardiovascular Surgery Specialist Assoc. Dr. Pointing out that even the smallest wound that is neglected in diabetes can turn into a very large and problematic condition, Selim Aydın said, “Diabetic foot that is not under control causes patients to cope with severe ischemic pains that cannot be relieved with painkillers while they are at rest, and even walking a short distance. It can cause them to have difficulties, and more importantly, to lose their feet or legs. For this reason, diabetic patients should pay great attention to their foot care, and should consult a doctor without wasting time when they notice cracks or wounds. says.
The problem of 1.5 million people in our country
According to studies, approximately 10-15 percent of diabetic patients face a diabetic foot ulcer at some point in their lives. In our country, which is estimated to have approximately 10 million diabetic patients, it is thought that 1-1,5 million patients struggle with diabetic foot ulcers. Made works; It shows that every 20 seconds, a foot loss occurs all over the world due to the complications caused by diabetes. Acıbadem University Atakent Hospital Cardiovascular Surgery Specialist Assoc. Dr. Pointing out that early intervention in the diabetic foot can prevent the process that will lead to limb loss, Selim Aydın said, “Today, many of the feet and legs can be prevented from being cut, thanks to the treatment of occlusions in the leg veins in diabetic feet and the accompanying wound care treatment. Moreover, most of the stenosis or occlusion in the leg veins can be treated endovascularly with closed methods applied through the vein without any incision, so patients can be discharged from the hospital in a short time.” gives the information.
Patients do not notice the wounds on their feet
Due to the deterioration of the sweating mechanism in diabetic patients, dry feet, cracks and crevices on the skin may develop. Cardiovascular Surgery Specialist Assoc. Dr. Selim Aydın stated that these cracks and crevices constitute the entry point for fungi and other infectious agents, and said, “Microbes entering through the cracks can cause serious infections in feet with problems in blood flow. Infection causes these cracks to grow and deepen. Healing of the wound is delayed due to insufficient blood supply to the foot as a result of vascular damage due to diabetes. As a result of the damage to the sensory nerves due to diabetes, the patient does not feel the infected wound and pain in his foot. By the time the patient becomes aware of the wound, the wound has already become threatening to the foot and leg. Therefore, it is of great importance in diabetic foot that patients check their feet regularly.
Treatment of stenosis and occlusions in the leg vessels due to diabetes can be performed as closed (endovascular) and open surgery. Cardiovascular Surgery Specialist Assoc. Dr. Selim Aydın stated that blood supply of at least one vein feeding the foot and fingers should be ensured with treatments for the healing of the wound developed due to diabetes, and said, “Today, with the closed methods called endovascular, the interventions made through the needle holes in the groin and / or foot veins, without any incision, very successful results in the blood supply of the feet. can be obtained.” says.
Balloon angioplasty
Balloon angioplasty remains the most common treatment method performed closed to clogged vessels. With this method, a balloon catheter sent through the vein can be inflated in the area where stenosis and occlusion have developed, and the stenosis can be relieved. The balloon is then lowered and retrieved. However, especially in diabetic patients, since the vessel walls are clogged with hard and petrified plaques, these plaques can rupture in approximately half of the patients who are applied balloons. For this reason, stents of various sizes and lengths are placed into the vein after the balloon procedure in order to prevent re-occlusion.
Vein shaving method
When stents are placed in very small and thin veins below the knee, these stents can become narrow and occluded in a short time, making it difficult for the vessels to reopen. Assoc. Dr. Stating that this problem is eliminated with the 'vein shaving' method called 'atherectomy', Selim Aydın continues as follows: “The method of vascular shaving – atherectomy, which is used to reduce the use of stents in the treatment of vascular occlusions, especially in the lower part of the groin and below the knee, is used to ensure better results. provides benefits. Before the balloon angioplasty procedure, when the hard and petrified plaques in the vessel are cut and removed by shaving the vessel, the vessel wall softens, therefore, tears do not occur in the vessel wall after the balloon procedure. In addition, when medicated balloons are used, which prolongs the open time of the vessel, the drug can penetrate the vessel wall better. Thanks to these effects, most patients do not need stents.”
Bypass method
Another method used in diabetic foot is bypass (bridging) surgery. Foot and leg nutrition can also be provided by open surgical procedures such as bypass surgery, which is performed using veins removed from the patient's own leg openly or closed (endoscopically). Cardiovascular Surgery Specialist Assoc. Dr. Selim Aydın, “Bypass surgery performed in patients whose veins cannot be opened with the closed method is also of vital importance for the recovery of the foot.” says.
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