Features of diagnostics and treatments of the patient with type 2 diabetes mellitus and chronic ischtmia with threating lower limb loss

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM
Diabetes Mellitus Pub Date : 2024-05-06 DOI:10.14341/dm13038
O. N. Bondarenko, M. Yaroslavceva, G. Galstyan, V. A. Larina, A. S. Petrosyan, N. Mokrysheva
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Abstract

The article presents the result of our own observation of the patient with a poor control of type 2 diabetes mellitus (DM) for a long period, complicated by obliterating atherosclerosis of the arteries of the lower extremities, Menckeberg’s sclerosis and chronic ischemia threatening loss of the lower extremity (CLLI). A feature of the clinical manifestation are complications associated with potentially regional (angiosomal) ischemia of the foot, as well as variant anatomy, represented by hypoplasia of the vascular lower leg in the patient. The clinical consequences of vascular calcification due to long-term decompensation of carbohydrate metabolism and the development of diabetic distal polyneuropathy (DDP) led to falsely high values of the cuff test in the patient. Disadvantages of non-invasive methods for diagnosing limb ischemia and advantages of the complex application of tests for diseases of the arteries of the lower extremities are discussed. Using WIFI classification according to the degree of ulceration, the degree of ischemia, and the degree of infection on the foot (Wound, Ischemia and Foot Infection), the tactics of managing the patient are presented. The important role of ultrasonic duplex scanning (USDS) in the visualization of the arteries of the legs and feet in patients with DM is substantiated. The importance of a multidisciplinary approach in the management of a comorbid patient with type 2 diabetes and CLTI is emphasized.
对有下肢缺失危险的 2 型糖尿病和慢性肢体缺血患者的诊断和治疗特点
本文介绍了我们对长期控制不良的 2 型糖尿病(DM)患者的观察结果,该患者并发有下肢动脉阻塞性粥样硬化、门克伯格氏硬化症和威胁下肢缺血的慢性缺血(CLLI)。临床表现的一个特点是与潜在的足部区域性(血管性)缺血相关的并发症,以及以患者小腿血管发育不良为代表的变异解剖结构。由于碳水化合物代谢长期失调导致血管钙化,以及糖尿病远端多发性神经病变(DDP)的临床后果导致患者的袖带检测值虚高。本文讨论了诊断肢体缺血的无创方法的缺点和下肢动脉疾病复杂应用测试的优点。根据溃疡程度、缺血程度和足部感染程度(伤口、缺血和足部感染)使用 WIFI 分类,介绍了管理患者的策略。超声双工扫描(USDS)在观察糖尿病患者腿部和足部动脉方面的重要作用得到了证实。强调了采用多学科方法管理 2 型糖尿病合并 CLTI 患者的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Diabetes Mellitus
Diabetes Mellitus ENDOCRINOLOGY & METABOLISM-
CiteScore
1.90
自引率
40.00%
发文量
61
审稿时长
7 weeks
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