A 5-year Follow-up Study Of Diabetic Foot Treated With Medication Perfusion By Femoral Artery

Objective: To observe the femoral artery perfusion treatment of diabetic foot(DF) patient outcomes five years, and compared with the conventional treatment group, comparative assessment of long-term efficacy, in order to provide clinicians with evidence-based medicine in the choice of treatment options for patients with diabetic foot. Through the new ulcers influencing factors analysis, the risk factors in order to guide the patient to avoid the risk factors, thereby reducing the DF ulcers in patients with new-onset. Methods : Select from January 2005 to December 2009 a total of 70 cases discharged healing diabetic foot. According to the treatment the patients were divided into drug perfusion group 35 cases and conventional treatment group 35 cases. These two sets of patient age, gender, disease duration, BMI, blood sugar and other indicators by analysis of variance was no significant difference((P> 0.05). Five years ago the conventional group uses a comprehensive treatment of the traditional local debridement and dressing, control blood sugar, combined intravenous systemic blood circulation, anti-infective therapy. Patients with drug perfusion group on the basis of the comprehensive treatment to the femoral artery of disposable infusion of thrombolytic agents and vasodilators. Application of Seldinger method in patients with ipsilateral or contralateral femoral artery puncture to enter the femoral artery of the lower limbs, popliteal artery, anterior tibial artery, posterior tibial artery, peroneal artery and dorsalis pedis artery tracking X-ray digital subtraction angiography. And then uniform batches of drugs infused into the left and right lower extremity arteries: urokinase 250000 u, papaverine 30 mg, anisodamine injection 10 ml, low molecular weight heparin, compound Salvia 30 ml.Re-imaging after administration. When see the increase in small blood vessels branch, improvement of stenosis or occlusion, exit the catheter. Two groups of patients were followed up, follow-up record new ulcers, ankle Brachial Index(ABI), glycated haemoglobin(HbA1c), vibration perception threshold(VPT), serum creatinine(SCr), carotid artery plaque, smoking, drinking and Barthel index. Multivariate Logistic regression analysis on the impact of new ulcers factors were analyzed. Results: The 70 patients were followed up rate is 100%. Two groups of ulcer recurrence rate of drug perfusion group is 34.3%, the conventional treatment group is 65.7%, the two groups had significant difference(P < 0.05). And drug perfusion group patients daily life ability determination of Barthel index is obviously better than the conventional group(P < 0.05). Independent risk factors for recurrence of ulcers is ABI(<1.0), HbA1c(≥7.0%), duration(≥10 years), carotid artery plaque formation, smoking(P <0.05). Conclusions:(1) Femoral artery Drug Perfusion DF long-term effects than conventional treatment effect, reducing the DF ulcer recurrence rate and improve the quality of life in patients with DF, reduce the financial burden on the patient’s family.(2) DF patients control HbA1c(<7.0%), ABI(≥1.0), quitting smoking, lowering blood cholesterol levels can reduce ulcer recurrence rate.(3) When clinicians preferred DF treatment programs, according to the indications choose femoral artery perfusion therapy, to achieve a significant short-term effect, but also reduce the long-term recurrence rate DF improve the quality of life of patients.