Publication: Relación entre las mediciones de TcPO2 en los angiosomas del pie pre y postrevascularización en pacientes con pie diabético
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2021-05-04
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Universidad Complutense de Madrid
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Abstract
Desde 1980, la prevalencia mundial de diabetes mellitus (DM) ha ascendido a casi el doble, del 4,7% al 8,5% en la población adulta, y según el octavo atlas de la International Diabetes Federation (IDF), se calcula que alrededor de 425 millones de personas en todo el mundo sufren DM. Si estas tendencias continúan, para el año 2045, 629 millones de personas sufrirán DM. La DM es un factor de riesgo mayor para el desarrollo de enfermedad arterial periférica (EAP) y dependiendo de su definición, la EAP puede afectar del 10-40% de la población de pacientes con DM, llegando al 49% en pacientes con pie diabético. La combinación de DM y EAP es devastadora, con una mortalidad a 5 años que se aproxima al 50%. Es indiscutible el papel de la revascularización en el tratamiento del pie diabético isquémico y neuroisquémico sin importar la técnica utilizada. Para ello, enfocar el diagnóstico correctamente es clave para la obtención de buenos resultados. Así mismo, son conocidas las dificultades en el diagnóstico por la calcificación de la capa media arterial y su falta de compresibilidad, la presencia de úlceras en los dedos o su ausencia, restando valor a los resultados del índice tobillo brazo (ITB) y del índice dedo brazo (IDB), y en ocasiones imposibilitando su realización. Por otro lado, debemos tener en cuenta que las características clínicas y morfológicas de los pacientes diabéticos difieren de aquellos que no lo son. Una alternativa para el diagnóstico, es la utilización de la presión transcutánea de oxígeno (TcPO2), ya que ha demostrado ser más precisa que el ITB y el IDB para el diagnóstico de EAP en pacientes diabéticos porque no se ve afectada por la calcificación arterial. Existe experiencia en la utilización de esta técnica para evaluar los resultados de la revascularización y su seguimiento a corto plazo. En cuanto a la revascularización del pie diabético existe actualmente un debate sobre las técnicas quirúrgicas disponibles, su selección en este grupo de pacientes y la utilidad o no de la revascularización guiada por angiosomas. Mediante este estudio hemos evaluado las fluctuaciones de los valores de TcPO2 en un grupo de pacientes diabéticos con lesión en el pie. Las mediciones se realizaron desde el diagnóstico y para el seguimiento tras la revascularización endovascular, midiendo siempre la presión de O2 en el territorio del angiosoma tibial anterior. De esta manera, pudimos extraer información sobre el impacto metabólico de la revascularización en los tejidos y su relación con las arterias tratadas en el pie...
Since 1980, the global cases of Diabetes Mellitus (DM) among the adult population have raised almost to the double, from 4,7 % to 8,5 %, and according to the eighth atlas of the International Diabetes Federation (IDF), around 425 millions of people all over the world are diagnosed from DM. If this tendecy remains, it is estimated that 629 millions of people will suffer form DM. DM becomes a higher risk factor for the development of Peripheral Artery Disease (PAD), and according to its definition, between 10 % and 40 % of patients with DM can be affected by the disease, reaching up to the 49%, taking account patients with Diabetic Foot. Also, the combination of DM with PAD has a mortality that approaches to 50 % over a period of 5 years. Despite the procedure that is used, the revascularization becomes a significant key for the treatment of the Ischaemic and Neuroischaemic Diabetic Foot. Therefore, focusing the diagnosis correctly is meaningful to obtain favorable results. In the same way, it is known that there are some difficulties to obtain a succesful diagnosis which can be a lack of stiffness of the medial arterial layer or the presence of calcification. Also the measurement of the Ankle Brachial Index (ABI) as well as the Toe Brachial Index (TBI) can be affected or even imposible to measure by the presence of ulcers in toes. It is always important to have in mind that patients with diabetes have some clinical and morfology differences comparing to the ones that are not diabetic. Once PAD is needed to be diagnosed in patients without signs of arterial calcification, the Transcutaneos Pressure of Oxygen (TcPO2) shows up as an alternative for diagnosis. It has been proved to be more precise than ABI and TBI, and is used to evaluate results in revascularization as well as a tool to make short term following up of the cases. Nowadays, there is a wide discussion around the selection of patients with Diabetic Foot, the current revascularization techniques that are used and also about the fact of using an angiosome-guided revascularization. This study is to evaluate how the TcPO2 has fluctuated in a group of revasculirazated diabetic patients with diabetic foot ulcer. The measurements of the O2 pressure had been always taken on the anterior tibial angiosome territory from the first diagnosis, and after having endovascular revascularization, so it was easy to get information about how the metabolic impact was on the tissues and its connection with the arteries treated in the foot...
Since 1980, the global cases of Diabetes Mellitus (DM) among the adult population have raised almost to the double, from 4,7 % to 8,5 %, and according to the eighth atlas of the International Diabetes Federation (IDF), around 425 millions of people all over the world are diagnosed from DM. If this tendecy remains, it is estimated that 629 millions of people will suffer form DM. DM becomes a higher risk factor for the development of Peripheral Artery Disease (PAD), and according to its definition, between 10 % and 40 % of patients with DM can be affected by the disease, reaching up to the 49%, taking account patients with Diabetic Foot. Also, the combination of DM with PAD has a mortality that approaches to 50 % over a period of 5 years. Despite the procedure that is used, the revascularization becomes a significant key for the treatment of the Ischaemic and Neuroischaemic Diabetic Foot. Therefore, focusing the diagnosis correctly is meaningful to obtain favorable results. In the same way, it is known that there are some difficulties to obtain a succesful diagnosis which can be a lack of stiffness of the medial arterial layer or the presence of calcification. Also the measurement of the Ankle Brachial Index (ABI) as well as the Toe Brachial Index (TBI) can be affected or even imposible to measure by the presence of ulcers in toes. It is always important to have in mind that patients with diabetes have some clinical and morfology differences comparing to the ones that are not diabetic. Once PAD is needed to be diagnosed in patients without signs of arterial calcification, the Transcutaneos Pressure of Oxygen (TcPO2) shows up as an alternative for diagnosis. It has been proved to be more precise than ABI and TBI, and is used to evaluate results in revascularization as well as a tool to make short term following up of the cases. Nowadays, there is a wide discussion around the selection of patients with Diabetic Foot, the current revascularization techniques that are used and also about the fact of using an angiosome-guided revascularization. This study is to evaluate how the TcPO2 has fluctuated in a group of revasculirazated diabetic patients with diabetic foot ulcer. The measurements of the O2 pressure had been always taken on the anterior tibial angiosome territory from the first diagnosis, and after having endovascular revascularization, so it was easy to get information about how the metabolic impact was on the tissues and its connection with the arteries treated in the foot...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Enfermería, Fisioterapia y Podología, leída el 02/10/2020