경피적 동맥확장술을 이용한 당뇨족 허혈의 치료

Abstract

Purpose: In treating diabetic foot ulcers, satisfactory vascularity is an essential prerequisite. To improve vascularity, a bypass graft has long been carried out. Recently, however, percutaneous transluminal angioplasty(PTA) has also been tried since the PTA is less invasive than the bypass graft. However, publication demonstrating the improvement of vascularity after the PTA are lacking. Therefore, this study was designed to show usefulness of the PTA in treating vasculopathy of diabetic foot. Materials: and Methods This study included 30 feet of 24 ischemic diabetic foot patients. Inclusion criteria were diabetes(duration>5years) and a significant lower extremity ischemia, as determined by a transcutaneous oxygen pressure(TcpO2)<30mmHg. The PTA was carried out in 61 arteries. PTA procedure was considered successful, when residual stenosis was less than 30%. The procedure was considered failed when residual stenosis was more than 50%. Residual stenosis between 30% and 50% was considered acceptable. For evaluation of PTA effect, foot TcpO2 and infrared thermography were measured before and 7th day after PTA.

Received July 7, 2009Revised September 25, 2009Accepted January 11, 2010Address Correspondence: Seung-Kyu Han, M.D., Department of Plastic Surgery, Korea University Guro Hospital, 97 Guro- dong, Guro-gu, Seoul 152-703, Korea. Tel: 02) 2626-3333/ Fax: 02) 868-6698 / E-mail: pshan@kumc.or.kr Results: Immediately after PTA performed in 61 arteries, 58 and 3 arteries were evaluated as being successful and acceptable, respectively. Before PTA, average foot TcpO2 was 12.6±8.8mmHg and its value was increased to 44.2±23.9 on 7th day after PTA(p<0.01). Average skin temperature was 31.8±1.2ﾟC before PTA and it was increased to 33.5±1.1ﾟC on 7th day after PTA (p<0.01). Conclusion: PTA procedure increases tissue oxygenation of ischemic diabetic feet which do not have wound healing potential due to low tissue oxygenation, to the level of possible wound healing. In addition, PTA increases skin temperature of ischemic diabetic feet which can imply an improvement of peripheral circulation.