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New procedure helps save limbs for diabetic patients

Prof. Pramook Mutirangura

Siriraj Hospital's surgeons have successfully developed a unique bypass procedure that can help diabetic patients with severe foot problems to avoid amputation.

With reduced blood supply to the lower limbs due to blocked or narrowing arteries in the legs, people with diabetes are at risk of developing serious foot ulcers and infections that could lead to amputation.

This new surgical strategy involves rerouting blood flow through the venous system to improve circulation in affected limbs instead of bypassing or opening the blocked portion of the artery as in conventional procedures.

A team of surgeons at Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, has performed this procedure on 40 patients since 2002.

Their research on the technique has been presented at international conferences in New York and London and recognized as an innovation in artery bypass surgery. It was also published in Vascular, the official journal of International Society for Vascular Surgery.

People with diabetes usually develop over time complications including heart disease, kidney disease, nerve damage, peripheral vascular disease, particularly in the foot, according to Prof. Supakorn Rojananin, M.D., head of the department.

Foot ulcers caused by inadequate blood supply due to the narrowing of arteries has been a major cause of amputations, disability and premature deaths for diabetic patients, he said.

Because of numbness from nerve damage, patients could experience loss of sensation in the feet and legs, weakness in muscles of the foot, and foot deformities. They may not be aware of foot injuries until infections develop. If left untreated for too long, the wounds could aggravate and become gangrene, which may lead to amputation of the foot or leg.

Diabetes is responsible for a number of amputations, which continues to rise each year, Prof. Supakorn said.

Artery bypass surgery and balloon angioplasty, possibly with a stent inserted to keep the artery wide open, are two standard procedures to treat blocked arteries of the legs, according to Prof. Pramook Mutirangura, head of Vascular Surgery Division, Department of Surgery.

Both procedures, however, are less reliable for successful outcomes when the farthest end of arteries in the leg is clogged or in critical condition, and the patient may end up with amputation anyway, he said.

Siriraj's unorthodox approach, on the other hand, can treat diabetic patients with artery blockage caused by the buildup of plaque made up of fatty materials and calcium which are so severe that they are unfit for other treatment options.

In this procedure, deep veins in the ankle are used as a conduit to supply blood from the arteries in the thigh directly into the foot venous system, according to Prof. Pramook.

With improved blood flow carrying sufficient oxygen and nutrients, the ulcers can heal properly allowing the patient to regain mobility.

It takes about 4 hours for the operation and 4-6 weeks of hospital stay for the patient.

In order to undergo surgery patients must healthy heart and lungs, and ankle veins that have suitable conditions. After the operation the patient needs to maintain blood sugar, blood pressure and triglyceride at appropriate levels and take antiplatelet drugs—medications that reduce the risk of blood clots. The patient is also advised to stop smoking completely since it increases the risk of arteries narrowing again,

Patients interested in this surgical treatment option can contact Surgical Disease Examination Unit on the third floor of Outpatient Building, Siriraj Hospital.



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