Amputation is a nightmare for diabetic foot patients. Over the past years, it became the only options for extensive ulcer. Nowadays, endovascular technique has been being developed to regenerate moribund tissue. This technique is known as Percutaneous Transluminal Angioplasty (PTA).
Diabetic foot is the most common form of peripheral arterial disease (PAD) in the lower limb. The fate of patients with diabetic foot generally is still disappointing, both for the patients themselves, as well as for the treating physician. Costs to be incurred to overcome the problem of diabetic foot are huge especially if it also counted losses and indirect costs due to disability and absence of patient work. In Indonesia, diabetic foot amputation rate ranges between 15-30% with a mortality rate of patients with ulcer / gangrene ranged between 17-32%.
Interventional therapy in cases of diabetic foot should be performed if severe PAD is found accompanied by non healing ulcers, or in a state of acute or critical limb ischemia. Symptoms may start within hours or several days, included intermittent pain in the legs at rest, muscle weakness, until paralysis. American College of Cardiology Foundation / American Heart Association and European Society of Cardiology recommends that the best options for this case is percutaneous transluminal angioplasty. Other option is bypass surgery.
Figure 1. Diabetic foot before and after PTA
Figure 2. Diabetic foot before and after PTA
Figure 3. Acute limb ischemia before and after PTA
Since first introduced in 1964, PTA technique has been tremendously improved in the treatment of patients with peripheral arterial disease. The success rate is quite high with low complication. Previously, this technique has been known to overcome the narrowed coronary arteries. Nowadays, it can be performed to overcome PAD cases, such as acute arterial insufficiency, deep vein thrombosis, diabetic foot and hemodialysis access. In the future, it will decrease amputation rate in diabetic foot patients. Currently, Cardiology Division has performed many PTA’s to handle diabetic foot cases.
(Pictures are private collection of dr. Dono Antono, SpPD-KKV, FINASIM, FICA)
Posted: February 18, 2016 at 12:45 pm, Last Updated: February 21, 2016 at 8:05 pm