Očuvanje udova i preživljenje dijabetičnih bolesnika s ishemijom donjih udova

We retrospectively analyzed the results of treatment of lower limb ischemia in 63 diabetic patients (27 female and 36 male, mean age 73.5 years) who were identified in a group of 138 randomly selected patients among those who had undergone lower limb arteriography during hospitalization at the Department of Vascular Medicine, Department of Radiology, Clinical Centre Ljubljana, in the year 1998. The reason for lower limb arteriography was claudication in 18 (29%), chronic critical ischemia in 42 (66%), and acute ischemia in three (5%) patients. After arteriography, the procedure of a revascularization was performed in 32 (51%) patients, among whom three patients with acute ischemia had successful embolectomy, 24 were treated endovascularly, and five patients surgically. Thirty (47%) patients were treated conservatively, and one patient with primary amputation. The patient status was reassessed after an average of 24 months, range 19 to 33 months. Among the 18 patients with claudication, two patients died, one from stroke and the other due to worsening of chronic obstructive pulmonary disease with respiratory failure, however, all patients retained their limb during the survival or follow-up, 15 after revascularization procedure and 18 with conservative treatment. Nine (21%) patients had amputation, four below and five above the knee. One amputation was primary, 2 amputations followed endovascular treatment, and 6 were performed after conservative treatment. During the follow-up period, 13 (31%) patients with chronic critical ischemia died, five from stroke, three from acute myocardial infarction, and five due to unknown causes. Our results have confirmed that lower limb ischemia can be treated relatively successfully in diabetic patients, but that mortality remains high, especially in patients with chronic critical ischemia.Retrospektivno smo analizirali rezultate liječenja ishemije donjih udova u 63 bolesnika sa šećernom bolešću (27 žena i 36muškaraca, prosječne dobi 73,5 god.) izdvojenih iz skupine od 138 slučajno odabranih bolesnika me.u onima kojima je tijekom 1998. god. za vrijeme hospitalizacije na Odjelu vaskularne medicine Odjela za radiologiju Kliničkog centra u Ljubljani učinjena arteriografija donjih udova. Razlozi za arteriografiju donjih udova bili su: klaudikacija u 18 (29%), kronična kritična ishemija u 42 (66%) i akutna ishemija u 3 (5%) bolesnika. Poslije arteriografije, postupak revaskularizacije proveden je u 32 (51%) bolesnika, od kojih je u troje bolesnika s akutnom ishemijom uspješno provedena embolektomija, 24 bolesnika liječeno je endovaskularno, a 5 bolesnika liječeno je kirurški. Tridesetoro (47%) bolesnika liječeno je konzervativno, a u jednoga je učinjena primarna amputacija. Status bolesnika ponovno je ocijenjen u prosjeku nakon 24 mjeseca (raspon 19-33 mjeseca). Od 18 bolesnika s klaudikacijom dvoje je umrlo, jedan zbog moždanog udara, a drugi zbog pogoršanja kronične opstrukcijske plućne bolesti sa zatajenjem respiracije. U svih su bolesnika u razdoblju preživljenja ili tijekom praćenja udovi bili očuvani, u 15 nakon postupka revaskularizacije, a u 18 uz konzervativno liječenje. U 9 (21%) bolesnika učinjena je amputacija (u 4 bolesnika ispod koljena, a u 5 iznad koljena). Jedna je amputacija bila primarna, 2 su uslijedile poslije endovaskularnog liječenja, a 6 poslije konzervativne terapije. Tijekom razdoblja praćenja umrlo je 13 (31%) bolesnika s kroničnom kritičnom ishemijom (5 zbog moždanog udara, 3 zbog akutnog infarkta miokarda, a 5 zbog nepoznatih uzroka). Naši rezultati potvrđuju da se ishemija donjih udova u bolesnika sa šećernom bolešću može liječiti razmjerno uspješno, no smrtnost je i dalje visoka, poglavito među bolesnicima s kroničnom kritičnom ishemijom