Saving the Limb: Diabetic Foot Through the Eyes of an Angiosurgeon

Saving the Limb: Diabetic Foot Through the Eyes of an Angiosurgeon

Why does the foot become vulnerable during diabetes?

When blood glucose levels are chronically high, it covertly destroys two vital systems: nerves and blood vessels. In angiosurgery (vascular surgery), we view this through three main aspects:

• Ischemia (circulatory deficiency): Diabetes accelerates atherosclerosis, which damages the small and medium-caliber arteries of the lower leg and foot.
• Neuropathy (loss of sensitivity): The patient experiences a decrease in sensitivity, causing even the smallest scratch to develop into a deep, infected ulcer.
• Infection: Elevated blood glucose levels lower immunity, which in some cases acts as a prerequisite for infectious complications and subsequent limb loss.

Angiosurgical Treatment Methods: How We Bring the Limb Back to Life

The primary objective of an angiosurgeon is revascularization—restoring blood flow to ischemic tissues. If the limb does not receive blood supply, even the most expensive ointments and antibiotics are useless. Today, we possess several high-tech methods in our arsenal:

1. Endovascular (Minimally Invasive) Surgery

This is the "gold standard" of modern medicine, particularly for elderly patients or those with multiple comorbidities, as it does not require large incisions or general anesthesia.

• Percutaneous Transluminal Angioplasty (PTA): A microcatheter is introduced into the blood vessel through the femoral artery, mechanically expanding the vessel lumen. Balloon angioplasty along the entire length of the small vessels of the lower leg is particularly effective. Even more successful is the use of special drug-eluting balloons, which prevent the re-narrowing (restenosis) of the vessel, thereby preserving the results of the balloon angioplasty for a long time.
• Stenting: If the vessel fails to expand adequately after balloon angioplasty or narrows again, a stent is placed in the same zone. The stent acts like a scaffold to hold the artery open, which is even more effective if the stent is drug-eluting.
• Atherectomy: Using specialized micro-instruments, calcified, hard atherosclerotic plaques are "scraped" (mechanically removed) and aspirated from the arterial wall, restoring free blood flow.

2. Open (Traditional) Reconstructive Operations

Despite the advancement of endovascular technologies, there are cases where open intervention is inevitable due to prolonged and complete occlusion (blockage) of the artery.

• Arterial Bypassing: This involves creating a "detour." An alternative blood vessel is sutured above and below the blocked area. The best option for a shunt is the patient's own saphenous vein (autograft), or, in its absence, a high-quality synthetic prosthesis.

3. Hybrid Interventions

This is a combination of endovascular and open surgery performed simultaneously on one operating table. For example, we perform an open bypass on a large blood vessel while simultaneously expanding the small arteries of the lower leg with a balloon. This grants us the opportunity to manage even the most complex, multi-level lesions.

4. Local Surgical Wound Management (Necrectomy)

In parallel with the restoration of blood circulation, sanitizing the local site is essential. We perform debridement (necrectomy)—the radical removal of dead, necrotic, and infected tissues from the wound down to the boundary of healthy tissue, allowing the restored blood circulation to initiate the regeneration process.

Multidisciplinary Approach at the Caucasus Medical Center

Treating a diabetic foot is impossible without a multidisciplinary approach. At the Caucasus Medical Center, highly qualified professionals—including an endocrinologist, vascular surgeon, plastic surgeon, microsurgeon, and infectious disease specialist—stepwise engage in the patient's treatment process.

Diabetic Foot Care Recommendations for the Patient:

• Daily Inspection: Examine your feet every evening (use a mirror if necessary).
• Moisturize the Skin: However, never apply cream between the toes (moisture causes fungal growth).
• No Self-Treatment: Forget about cutting corns yourself and avoid sharp objects.
• Manage Diabetes: This is the absolute foundation. Even our best surgery will only be temporary if your glycemia goes out of control.
• Strictly Avoid: Placing limbs in hot or cold water, as well as contrast baths.
• Wear properly fitted, soft shoes.
• Seek immediate medical attention upon noticing any suspicious spots or rashes.

Key Message: Amputation is not the natural conclusion of diabetes; it is merely the result of delayed medical intervention. Modern angiosurgery possesses immense resources for saving limbs—the key factor is timely treatment.

Giorgi Jinchveladze

MD; Head of Vascular and Endovascular Surgery; Vascular Surgeon; Angiologist