Spiliopoulos S, Festas G, Paraskevopoulos I, Mariappan M, Brountzos E. Overcoming ischemia in the diabetic foot: Minimally invasive treatment options. World J Diabetes 2021; 12(12): 2011-2026 [PMID: 35047116 DOI: 10.4239/wjd.v12.i12.2011]
Corresponding Author of This Article
Stavros Spiliopoulos, MD, PhD, Associate Professor, Second Department of Radiology, Interventional Radiology Unit, Attikon University Hospital, Rimini Street 1, Athens 12461, Greece. stavspiliop@med.uoa.gr
Research Domain of This Article
Peripheral Vascular Disease
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. Dec 15, 2021; 12(12): 2011-2026 Published online Dec 15, 2021. doi: 10.4239/wjd.v12.i12.2011
Overcoming ischemia in the diabetic foot: Minimally invasive treatment options
Stavros Spiliopoulos, Georgios Festas, Ioannis Paraskevopoulos, Martin Mariappan, Elias Brountzos
Stavros Spiliopoulos, Georgios Festas, Second Department of Radiology, Interventional Radiology Unit, Attikon University Hospital, Athens 12461, Greece
Ioannis Paraskevopoulos, Martin Mariappan, Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB25 2ZN, United Kingdom
Elias Brountzos, Second Department of Radiology, School of Medicine; National and Kapodistrian University of Athens, Athens 12461, Greece
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Stavros Spiliopoulos, MD, PhD, Associate Professor, Second Department of Radiology, Interventional Radiology Unit, Attikon University Hospital, Rimini Street 1, Athens 12461, Greece. stavspiliop@med.uoa.gr
Received: February 22, 2021 Peer-review started: February 22, 2021 First decision: June 5, 2021 Revised: July 13, 2021 Accepted: October 31, 2021 Article in press: October 31, 2021 Published online: December 15, 2021
Abstract
As the global burden of diabetes is rapidly increasing, the incidence of diabetic foot ulcers is continuously increasing as the mean age of the world population increases and the obesity epidemic advances. A significant percentage of diabetic foot ulcers are caused by mixed micro and macro-vascular dysfunction leading to impaired perfusion of foot tissue. Left untreated, chronic limb-threatening ischemia has a poor prognosis and is correlated with limb loss and increased mortality; prompt treatment is required. In this review, the diagnostic challenges in diabetic foot disease are discussed and available data on minimally invasive treatment options such as endovascular revascularization, stem cells, and gene therapy are examined.
Core Tip: Recognizing and promptly treating ischemia in patients with diabetic foot ulcers is essential for wound healing and limb salvage. A plethora of novel minimally invasive technologies and techniques are currently available, including dedicated peripheral angioplasty balloon catheters, drug-eluting stents, drug-coated balloons, angiosome-guided angioplasty, pedal arch angioplasty, and percutaneous deep vein arterialization, while research on gene and stem cell therapies is ongoing and initial data are deemed positive. Large, multicenter randomized trials specifically focused on optimizing endovascular treatment options for diabetic foot ulcers remain limited, and more high-quality, long-term, data are expected.
