Seminars in Vascular Surgery最新文献_第5页

Diabetic foot in primary and tertiary (DEFINITE) care: An efficacious, synergistic and cost-effective multidisciplinary team model for diabetic foot care in Singapore 糖尿病足在初级和三级（明确）护理：一个有效的，协同的和具有成本效益的多学科团队模式糖尿病足护理在新加坡

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery

Pub Date : 2025-03-01 DOI: 10.1053/j.semvascsurg.2025.01.007

Wen Zhe Leo , Lixia Ge , Sadhana Chandrasekar , Elaine Tan , Yi Bing Loh , Xiaoli Zhu , Huiling Liew , Enming Yong , Tiffany Chew , Jeremy Hoe , Chelsea Law , Jaime Lin , Jo Anne Lim , Pravin Lingam , Joseph Molina , Gary Ang , Yan Sun , Zhiwen Joseph Lo , DEFINITE (Diabetic Foot in Primary and Tertiary) Care Team

Diabetic foot ulcers (DFUs) and lower extremity amputations (LEAs) threaten survival and quality of life (QoL) of patients, contributing to healthcare and economic burden. Guidelines advocate for a multidisciplinary team (MDT) approach, but limited literature exists on cost-effectiveness and collaboration with primary care. We present the outcomes of the Diabetic Foot in Primary and Tertiary (DEFINITE) Care program, an MDT initiative in Singapore across primary and tertiary care. Patients with DFU from June 2020 to 2022 were enrolled. Clinical outcomes encompassed one-year minor and major LEAs, mortality and LEA-free survival rates. Healthcare utilization outcomes included number of admissions, length of stay, and primary care and hospital visits. QoL and Patient Reported Outcome Measures (PROMs) were respectively assessed using the EuroQol Five-Dimensional Questionnaire and Diabetic Foot Ulcer Scale-Short Form. Results from DEFINITE were propensity-score matched against a retrospective cohort. Cost-effectiveness analysis was performed using Markov simulation. Subgroup analyses focused on at-risk populations, including patients without access to MDT clinics or podiatry, appointment defaulters, octogenarians, patients with end-stage renal failure and different primary care locations. Total of 2,798 patients, with a mean age of 65.7 years and majority males (61.4%), were included for analysis. DEFINITE Care patients had higher minor LEA and improved LEA-free survival rates, fewer and shorter hospital admissions, and enhanced QoL and PROMs. DEFINITE Care demonstrated greater cost-effectiveness when compared to traditional care. Outcomes varied among subgroups. DEFINITE Care is an efficacious and cost-effective MDT model which fosters collaboration between primary and tertiary care for diabetic limb salvage.

糖尿病足溃疡（DFUs）和下肢截肢（LEAs）威胁患者的生存和生活质量（QoL），造成医疗保健和经济负担。指南提倡多学科团队（MDT）方法，但关于成本效益和与初级保健合作的文献有限。我们介绍了糖尿病足初级和三级（DEFINITE）护理项目的结果，这是新加坡初级和三级护理的MDT倡议。纳入了2020年6月至2022年的DFU患者。临床结果包括一年轻微和主要LEAs、死亡率和无LEAs生存率。医疗保健利用结果包括入院次数、住院时间、初级保健和医院就诊次数。使用EuroQol五维问卷和糖尿病足溃疡量表-短表分别评估生活质量和患者报告的结果测量（PROMs）。来自DEFINITE结果与回顾性队列的倾向评分相匹配。采用马尔可夫模拟进行成本-效果分析。亚组分析侧重于高危人群，包括无法获得MDT诊所或足部治疗的患者、预约不履行者、80多岁老人、终末期肾衰竭患者和不同初级保健地点的患者。共纳入2798例患者，平均年龄65.7岁，多数为男性（61.4%）。明确护理患者有更高的轻微LEA和改善的无LEA生存率，更少和更短的住院时间，改善的生活质量和PROMs。与传统护理相比，明确护理显示出更高的成本效益。亚组间结果不同。明确护理是一种有效和具有成本效益的MDT模式，促进糖尿病肢体抢救的初级和三级护理之间的合作。

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引用次数: 0

The role of flaps in preventing lower extremity amputations 皮瓣在预防下肢截肢中的作用

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery

Pub Date : 2025-03-01 DOI: 10.1053/j.semvascsurg.2025.01.013

John M. Felder, Emmanuel Nageeb, Ingrid Rocha, Ryan Qasawa, Syena Moltaji, Yuma Fuse

The increasing prevalence of chronic limb-threatening ischemia and diabetes mellitus has led to a surge in lower extremity amputations, driven by the combination of peripheral arterial disease and extensive wounds. Although revascularization often addresses ischemia, severe wounds pose a significant risk of amputation. Flaps, which involve the transfer of vascularized tissue, can provide immediate closure of complex wounds, particularly those involving bone or tendon exposure, where skin grafts are insufficient. Flap reconstruction of wounds can prevent amputation in cases when revascularization alone would not, but these complex efforts require close collaboration between vascular and plastic surgeons. Despite their potential to prevent amputations, flaps are underused in vascular surgery due to limited availability and expertise, particularly in complex cases involving diabetes and peripheral vascular disease. There are also socioeconomic and reimbursement challenges that limit interest on the part of plastic surgeons. This article explores the principles, techniques, and challenges of flap reconstruction in lower extremity limb salvage, emphasizing the need for multidisciplinary care.

慢性肢体威胁缺血和糖尿病的患病率日益增加，导致下肢截肢的激增，这是由外周动脉疾病和大面积伤口共同驱动的。虽然血运重建术经常解决缺血问题，但严重的伤口会造成截肢的重大风险。皮瓣涉及血管化组织的转移，可以立即关闭复杂的伤口，特别是那些涉及骨或肌腱暴露的伤口，皮肤移植是不够的。在单纯血运重建术无法避免截肢的情况下，皮瓣重建伤口可以避免截肢，但这些复杂的努力需要血管外科医生和整形外科医生之间的密切合作。尽管皮瓣具有预防截肢的潜力，但由于可用性和专业知识有限，特别是在涉及糖尿病和周围血管疾病的复杂病例中，皮瓣在血管手术中的应用不足。此外，社会经济和报销方面的问题也限制了整形外科医生的兴趣。本文探讨了残肢残肢皮瓣重建的原理、技术和挑战，强调了多学科治疗的必要性。

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引用次数: 0

Best practice offloading treatments for diabetic foot ulcer healing, remission, and better plans for the healing-remission transition 最佳实践卸载治疗的糖尿病足溃疡愈合，缓解和更好的计划，为愈合缓解过渡

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery

Pub Date : 2025-03-01 DOI: 10.1053/j.semvascsurg.2025.01.012

Peter A. Lazzarini , Jaap J. van Netten

Diabetes-related foot disease is arguably the world's least known major health problem and causes a disease burden larger than most well-known diseases, such as stroke and breast cancer. This burden is driven by people developing more severe stages of foot disease, such as foot ulcers and infections, and with that worsening quality of life. To reduce this burden, we need treatments that prevent more severe stages of foot disease and improve quality of life. Best practice offloading treatments have been found to be arguably the most effective existing treatments to heal and prevent diabetes-related foot ulcers and infections, but can worsen quality of life. Furthermore, high re-ulceration rates still occur with best practice offloading treatments after healing. This may be because of the gap in guideline recommendations on the transition from ulcer healing to ulcer remission when it comes to offloading treatments. In this paper, we review why we need offloading treatments and what are the best offloading treatments recommended by the latest international guidelines for healing and remission. Further, we propose plans for future best practice offloading treatments for the transition from healing-to-remission to help reduce re-ulceration rates and improve longer-term ulcer remission. These plans could be the catalyst for better transitioning patients from first ulcer presentation through healing and into long-term remission, and in turn delivering better quality of life, and lower diabetes-related foot disease burdens on patients, nations, and the globe in future.

糖尿病相关足病可以说是世界上最不为人所知的重大健康问题，其造成的疾病负担比大多数众所周知的疾病（如中风和乳腺癌）都要大。造成这种负担的原因是，人们出现了更严重的足部疾病阶段，如足部溃疡和感染，生活质量也随之恶化。为了减轻这一负担，我们需要预防更严重阶段的足病和改善生活质量的治疗方法。最佳实践卸载治疗被认为是现有治疗和预防糖尿病相关足部溃疡和感染的最有效的方法，但可能会使生活质量恶化。此外，高再溃疡率仍然发生在愈合后的最佳做法卸载治疗。这可能是因为当涉及到卸载治疗时，从溃疡愈合过渡到溃疡缓解的指南建议存在差距。在本文中，我们回顾了为什么我们需要卸载治疗，以及最新的国际愈合和缓解指南推荐的最佳卸载治疗是什么。此外，我们提出了从愈合到缓解过渡的未来最佳实践卸载治疗计划，以帮助减少再溃疡率并改善长期溃疡缓解。这些计划可以成为催化剂，使患者从首次溃疡表现更好地过渡到愈合并进入长期缓解，进而提供更好的生活质量，并在未来降低患者、国家和全球的糖尿病相关足病负担。

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引用次数: 0

Fundamentals of wound care for amputation prevention 预防截肢的伤口护理基础

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery

Pub Date : 2025-03-01 DOI: 10.1053/j.semvascsurg.2025.01.001

Beatriz Moschiar Almeida , Robyn Evans , Ahmed Kayssi

The initial skin breakdown and subsequent healing processes are complex and influenced by various parameters, including systemic factors, infectious bioburden, and perfusion. Vascular wounds comprise inadequate inflow (due to peripheral artery disease), microvascular damage (result of diabetes mellitus), or vasoconstriction. Normal healing of acute wounds occurs in a sequence of defined stages; however, if a dysregulated inflammatory state ensues, it is classified as chronic. Both chronic and vascular wounds carry an increased risk of amputation. Therefore, holistic wound care is crucial in preventing limb loss. This review outlines a systematic approach to wound assessment and examines the latest recommendations for managing vascular wounds, focusing on strategies for preventing amputations.

最初的皮肤破裂和随后的愈合过程是复杂的，并受到各种参数的影响，包括全身因素、感染性生物负荷和灌注。血管创伤包括血流不足（由于外周动脉疾病）、微血管损伤（糖尿病所致）或血管收缩。急性伤口的正常愈合发生在一系列确定的阶段；然而，如果一个失调的炎症状态随之而来，它被归类为慢性。慢性和血管性伤口都增加了截肢的风险。因此，全面的伤口护理是防止肢体丧失的关键。这篇综述概述了一种系统的伤口评估方法，并检查了管理血管伤口的最新建议，重点是预防截肢的策略。

引用次数: 0

Diabetic foot infections: Questions for an infectious disease consultant 糖尿病足部感染：传染病顾问的问题

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery

Pub Date : 2025-03-01 DOI: 10.1053/j.semvascsurg.2025.01.009

Varidhi Nauriyal , Karin Byers

Diabetic foot infection can lead to limb amputation in approximately 17% of affected patients. Given the complex pathophysiology associated with diabetic foot infection, the goal of limb preservation is best achieved with a multidisciplinary approach and a team of providers including infectious disease consultants. However, these infections often affect populations living in nonmetropolitan areas, where access to an infectious disease physician may be limited. It may fall on the surgeons and primary care providers to not only diagnose infections early, including osteomyelitis, but also facilitate prompt, appropriate antibiotic management. The decision to treat with antibiotics alone versus surgery, choice of antibiotic, route of administration, and duration of treatment are complicated concepts that require a patient-specific approach. In addition, use of oral antibiotics and long-acting lipoglycopeptides has gained prominence and offers an alternate solution to the tedious, resource-intense process of outpatient intravenous antibiotic treatment. The goal of this article is to outline and address diagnostic and management questions that would be posed to an infectious disease consultant. The responses would include a literature review of current management concepts and highlights from the 2023 Infectious Disease Society of America and International Working Group on the Diabetic Foot guidelines.

糖尿病足感染可导致约17%的患者截肢。考虑到与糖尿病足感染相关的复杂病理生理，肢体保存的目标最好通过多学科方法和包括传染病顾问在内的提供者团队来实现。然而，这些感染通常影响生活在非大都市地区的人群，在那里获得传染病医生的机会可能有限。外科医生和初级保健提供者不仅要及早诊断感染，包括骨髓炎，而且要促进及时、适当的抗生素治疗。决定单独使用抗生素还是手术，抗生素的选择，给药途径和治疗时间是复杂的概念，需要针对具体患者的方法。此外，口服抗生素和长效脂糖肽类药物的使用日益突出，为门诊静脉注射抗生素治疗的繁琐、资源紧张的过程提供了另一种解决方案。这篇文章的目的是概述和解决诊断和管理问题，将提出一个传染病顾问。回应将包括对当前管理概念的文献综述，以及2023年美国传染病学会和国际糖尿病足指南工作组的重点内容。

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引用次数: 0

The role of physical therapy in managing peripheral artery disease and diabetes 物理治疗在外周动脉疾病和糖尿病中的作用

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery

Pub Date : 2025-03-01 DOI: 10.1053/j.semvascsurg.2025.01.006

Stephanie L. Woelfel , Deborah M. Wendland

Peripheral artery disease and diabetes mellitus impact millions of adults in the United States and their combined effects are severe, resulting in loss of limb and loss of life. A strong multidisciplinary team is required to comprehensively care for this complicated patient population. As movement specialists, physical therapists are essential members of this team. Many of these patients will benefit from an individualized exercise and mobility prescription for not only disease and wound management but also for safe return to activity once any associated wounds have closed. Specialized care and loading guidance are necessary, especially for the closed but still healing skin. The purpose of this review is to highlight the role of physical therapists as team members in caring for patients with vascular compromise and/or diabetes mellitus. Furthermore, the value added for patient care and outcomes will be emphasized.

外周动脉疾病和糖尿病影响着美国数以百万计的成年人，它们的综合影响是严重的，导致肢体丧失和生命丧失。需要一个强大的多学科团队来全面照顾这一复杂的患者群体。作为运动专家，物理治疗师是这个团队的重要成员。这些患者中的许多人将受益于个性化的运动和活动处方，不仅对疾病和伤口管理，而且一旦任何相关伤口愈合，也可以安全返回活动。专业护理和负荷指导是必要的，特别是对于闭合但仍在愈合的皮肤。本综述的目的是强调物理治疗师作为团队成员在照顾血管受损和/或糖尿病患者中的作用。此外，将强调为患者护理和结果增加的价值。

引用次数: 0

In the know with toe and flow 在知道脚趾和流动

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery

Pub Date : 2025-03-01 DOI: 10.1053/j.semvascsurg.2025.01.010

Ahmed Kayssi , Samantha Minc , David G. Armstrong

引用次数: 0

A scoping review of limb preservation interventions with primary care providers caring for US Indigenous patients with diabetes and peripheral artery disease 对美国土著糖尿病和外周动脉疾病患者的初级保健提供者的肢体保留干预措施的范围审查

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery

Pub Date : 2025-03-01 DOI: 10.1053/j.semvascsurg.2025.01.003

Juell Homco , Thane Gehring , W. Landon Jackson , Wato Nsa , Madison Whitekiller , Shari Clifton , Peter R. Nelson , Blake Lesselroth , Kelly Kempe

Amputation disparities due to diabetes and peripheral artery disease occur among vulnerable and historically mistreated populations. In Oklahoma, some of the highest amputation rates occur in Indigenous residents. Knowing that primary care providers are often the first to tackle prevention and assess at-risk limbs, we sought to understand the historical efforts made by primary care providers in this high-risk population. This scoping review evaluates the literature to summarize prior amputation prevention interventions and their characteristics, including the outcome metrics used among Indigenous populations in the United States. We searched MEDLINE using a combination of Medical Subject Headings and keywords related to amputation, limb preservation, limb salvage, and American Indian and Indigenous health inequities or disparities and ethnicity. We conducted our final search on October 4, 2024, including articles in English and those that focused on primary care practice-based interventions. We excluded case reports, trauma- or oncologic-related amputations, or articles describing interventions not conducted in the United States. We identified 404 articles and 3 fit the review criteria. All interventions were analyses of programs to improve diabetes care. All interventions occurred between 1986 and 2001 and were multilevel in structure. Intervention strategies used included expanded infrastructure, provider and patient education, implementation of clinical workflow and provider metrics, community awareness projects, foot-care expertise and footwear, and field visits. No interventions specifically targeted peripheral artery disease. This scoping review identifies a significant contemporary gap in amputation reduction interventions among Indigenous populations in the United States and highlights multiple areas where interventions may be needed to combat ongoing amputation disparities for a high-risk population.

由于糖尿病和外周动脉疾病导致的截肢差异发生在脆弱和历史上被虐待的人群中。在俄克拉荷马州，一些最高的截肢率发生在土著居民身上。了解到初级保健提供者通常是第一个解决预防和评估危险肢体的人，我们试图了解初级保健提供者在这一高危人群中所做的历史努力。本综述评估了文献，总结了先前的截肢预防干预措施及其特点，包括在美国土著人口中使用的结果指标。我们结合医学主题标题和与截肢、肢体保存、肢体保留、美洲印第安人和土著居民健康不平等或差异和种族相关的关键词搜索MEDLINE。我们在2024年10月4日进行了最后的搜索，包括英语文章和那些专注于初级保健实践干预的文章。我们排除了病例报告，创伤或肿瘤相关截肢，或描述非在美国实施的干预措施的文章。我们确定了404篇文章，其中3篇符合评审标准。所有的干预都是对改善糖尿病护理项目的分析。所有干预都发生在1986年至2001年之间，并且是多层次的结构。所采用的干预策略包括扩大基础设施、提供者和患者教育、实施临床工作流程和提供者指标、社区意识项目、足部护理专业知识和鞋类以及实地访问。没有针对外周动脉疾病的干预措施。本综述确定了当代美国土著人群在截肢减少干预方面的重大差距，并强调了可能需要干预的多个领域，以消除高风险人群持续存在的截肢差异。

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引用次数: 0

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery

Pub Date : 2025-03-01 DOI: 10.1053/j.semvascsurg.2025.01.002

Levi M. Brooks , Bradley M. Brooks , Allison S. Arp , Cyaandi R. Dove , Lee C. Rogers , Rosemay Michel , Valentina Clinton , Jonathan Labovitz , Brandon M. Brooks , David G. Armstrong

Of the roughly 38 million people diagnosed with type 2 diabetes mellitus in the United States, up to 34% will develop a diabetic foot ulcer at some point, up to 75% of those who develop an ulcer will experience recurrent ulcers, and approximately 18% of patients with a diabetic foot ulcer will undergo lower-limb amputation. The aim of this study was to determine whether depressive symptoms change after a minor, nontraumatic amputation. We conducted a multimethod study consisting of semi-structured interviews (n = 12) and a retrospective cohort (n = 20) of patients with type 2 diabetes mellitus who underwent a nontraumatic, minor amputation of a single toe (partial or total) or partial ray resection. Patient Health Questionnaire-9 (PHQ-9) scores were noted before and after surgery within 30 days of each other. The Wilcoxon matched pairs signed rank test was used to determine differences in the PHQ-9 scores before amputation and after amputation. Of the 20 patients in the retrospective cohort, 90% (18 of 20) had higher PHQ-9 scores within 30 days of amputation. Mean PHQ-9 scores were 3.65 and 12.35 before and after amputation, respectively (a difference of 8.7; P = .0001). Diabetes-related extremity amputation depression and distress is a potentially dangerous complication of diabetes mellitus. Nontraumatic amputations can be a traumatic experience for patients. Surgeons should screen their patients with type 2 diabetes mellitus before and after any (minor or major) nontraumatic amputation and make the appropriate referral, if necessary. Sufficient evidence exists in the literature to warrant the inclusion of psychiatrists and other mental health clinicians in multidisciplinary limb preservation teams.

在美国大约3800万被诊断为2型糖尿病的人中，高达34%的人会在某个时候患上糖尿病足溃疡，高达75%的溃疡患者会复发性溃疡，大约18%的糖尿病足溃疡患者会进行下肢截肢。本研究的目的是确定轻度非创伤性截肢后抑郁症状是否会改变。我们进行了一项多方法研究，包括半结构化访谈（n = 12）和回顾性队列（n = 20），这些2型糖尿病患者接受了单趾（部分或全部）的非创伤性小截肢或部分射线切除术。患者健康问卷-9 （PHQ-9）评分分别于手术前后30天内记录。采用Wilcoxon配对对符号秩检验测定截肢前后PHQ-9评分的差异。在回顾性队列中的20例患者中，90%（20例中的18例）在截肢后30天内PHQ-9评分较高。截肢前后平均PHQ-9评分分别为3.65分和12.35分(差异8.7分；P = 。)。糖尿病相关性截肢、抑郁和窘迫是糖尿病的一种潜在危险并发症。非创伤性截肢对患者来说可能是一种创伤性经历。外科医生应在非创伤性截肢手术前后对2型糖尿病患者进行筛查，并在必要时进行适当的转诊。文献中有足够的证据证明精神科医生和其他心理健康临床医生应被纳入多学科肢体保存小组。

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引用次数: 0

Percutaneous approach to deep vein arterialization for the “no-option” chronic limb-threatening ischemia patient 经皮深静脉动脉化治疗“无选择”的慢性肢体缺血患者

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery

Pub Date : 2025-03-01 DOI: 10.1053/j.semvascsurg.2025.01.005

Jayne R. Rice, Brett C. Chatman, Elizabeth A. Genovese

Chronic limb-threatening ischemia is an advanced stage of peripheral artery disease characterized by rest pain or tissue loss. Treatment of patients classified as ``no-option'' CLTI remains particularly challenging, as historically their primary treatment has been limited to major amputation. Venous arterialization has emerged as a promising alternative in this difficult-to-treat population. Advances in optimized technology and endovascular techniques, particularly deep venous arterialization, have had encouraging outcomes for long-term limb salvage. Successful limb preservation relies on proper patient selection, a compliant patient, and a robust multidisciplinary clinical team to support the complex processes of deep venous arterialization maturation and wound healing. This review will discuss the historical background of venous arterialization, patient selection criteria, and surgical techniques for percutaneous deep venous arterialization, and postoperative management after the index procedure, including wound care, surveillance, and reintervention strategies for successful limb salvage.

慢性肢体威胁缺血是外周动脉疾病的晚期，其特征是静息疼痛或组织丧失。被归类为“无选择”的CLTI患者的治疗仍然特别具有挑战性，因为历史上他们的主要治疗仅限于主要截肢。静脉动脉化已成为这一难以治疗的人群的一个有希望的选择。优化技术和血管内技术的进步，特别是深静脉动脉化，在长期肢体保留方面取得了令人鼓舞的结果。成功的肢体保留依赖于正确的患者选择，一个顺从的患者，以及一个强大的多学科临床团队来支持深静脉动脉化、成熟和伤口愈合的复杂过程。本文将讨论静脉动脉化的历史背景，患者选择标准，经皮深静脉动脉化的手术技术，以及指数手术后的术后管理，包括伤口护理，监测和成功挽救肢体的再干预策略。

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引用次数: 0