Diabetes and Peripheral Vascular Disease: Diagnosis and Management

248 Pages·2012·5.673 MB·English

by  Rishi Kundi M.D., Andrew J. Meltzer M.D. (auth.), Gautam V. Shrikhande, James F. McKinsey (eds.)

C D
ONTEMPORARY IABETES
Aristidis Veves, MD, DSc, Series Editor
For further volumes:
http://www.springer.com/series/7679
wwwwwwwwwwww
Gautam V. S hrikhande (cid:129) J ames F. McKinsey
Editors
Diabetes and Peripheral
Vascular Disease
Diagnosis and Management
Editors
Gautam V. Shrikhande, MD James F. McKinsey, MD, FACS
Division of Vascular Surgery and Division of Vascular Surgery and
Endovascular Interventions Endovascular Interventions
Columbia University College of Columbia University College of
Physicians and Surgeons Physicians and Surgeons
New York Presbyterian Hospital New York Presbyterian Hospital
New York, NY New York, NY
USA USA
ISBN 978-1-62703-157-8 ISBN 978-1-62703-158-5 (eBook)
DOI 10.1007/978-1-62703-158-5
Springer New York Heidelberg Dordrecht London
Library of Congress Control Number: 2012949162
© Springer Science+Business Media New York 2012
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, speci fi cally the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on micro fi lms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed. Exempted from this
legal reservation are brief excerpts in connection with reviews or scholarly analysis or material
supplied speci fi cally for the purpose of being entered and executed on a computer system, for
exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is
permitted only under the provisions of the Copyright Law of the Publisher’s location, in its
current version, and permission for use must always be obtained from Springer. Permissions for
use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable
to prosecution under the respective Copyright Law.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a speci fi c statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
While the advice and information in this book are believed to be true and accurate at the date of
publication, neither the authors nor the editors nor the publisher can accept any legal responsibility
for any errors or omissions that may be made. The publisher makes no warranty, express or
implied, with respect to the material contained herein.
Printed on acid-free paper
Humana Press is part of Springer Science+Business Media (www.springer.com)
To those who have trained us when we were students, residents,
and fellows and to the students, residents, and fellows that we
are fortunate to train in our quest to advance the fi eld of
vascular and endovascular interventions.
wwwwwwwwwwww
Preface
The incidence and prevalence of peripheral vascular disease continues to rise
in our aging population. Diabetic patients are at a higher risk of atheroscle-
rotic disease in all arterial beds of the human body. We have asked leaders in
the fi eld of medicine, podiatry, and vascular and endovascular therapy to
assimilate the latest literature for an in-depth review of the management of
peripheral vascular disease. The objective of this textbook is to provide an
overview of the management of diabetes and diabetic foot changes as well as
providing a view of cutting-edge and emerging topics in optimization of arte-
rial status. We have addressed pathophysiology, anatomy, diagnosis, and
management of diabetic peripheral vascular disease emphasizing a multidis-
ciplinary approach.
The fi rst chapter of the book provides an overview of this complex disease
process and discusses the teamwork required for optimal management. The
chapters continue with the basic pathophysiology of diabetic atherosclerosis
and a contemporary review of the management of diabetes. Next, we discuss
the genesis of diabetic foot ulceration and prevention and management strate-
gies. The effects of neuropathy and microvascular changes in the diabetic
foot are highlighted. We then speci fi cally address the microbiology of dia-
betic foot infections. Assessment of arterial status is discussed as improving
blood fl ow becomes paramount in peripheral vascular disease. The role of
endovascular interventions and vascular surgery as well as the management
of the complications of these procedures are described in the setting of diabe-
tes. As a last resort, the process of amputation is discussed for those patients
who have progressed beyond a limb salvage situation. The effects of diabetes
on the cerebrovascular system as well as its implications in patients with
aortoiliac disease are discussed. The book concludes with a chapter on emerg-
ing endovascular technologies including drug eluting balloons and stents.
The chapters throughout the book will describe and evaluate the results of
recent, applicable clinical trials.
The intended audience for this book includes internists, family practitio-
ners, surgeons, podiatrists, wound care specialists, and vascular specialists.
Students, residents, and fellows in surgical and medical specialties should
also fi nd this book of signi fi cant value and interest, as it may help them shape
how they will approach peripheral vascular disease, diabetes, and their subse-
quent complications.
We are fortunate to have bene fi ted from the expertise of the renowned
authors who contributed to this book. We want to thank them for the time and
vii
viii Preface
effort that they contributed to this project; they represent the multidisciplinary
approach required for management of this dif fi cult problem. It is our hope
that this book will be an invaluable reference for all clinicians concerned with
diabetes and peripheral vascular disease.
New York , NY , USA Gautam V. Shrikhande, M.D.
New York , NY , USA James F. McKinsey, M.D.
Contents
1 General Considerations in the Diabetic Patient
with Peripheral Vascular Disease .............................................. 1
Rishi Kundi, Andrew J. Meltzer, and Danielle Bajakian
2 The Pathogenesis of Diabetic Atherosclerosis .......................... 13
Jeffrey J. Siracuse and Elliot L. Chaikof
3 Diabetes Mellitus and Peripheral Vascular Disease ................. 27
Matthew J. Freeby
4 Diabetic Neuropathy ................................................................... 39
Francesco Tecilazich, Thanh L. Dinh, and Aristidis Veves
5 Microvascular Changes in the Diabetic Foot ........................... 53
Thomas S. Monahan
6 Diabetic Foot Ulceration and Management .............................. 63
Peter A. Blume, Akhilesh K. Jain, and Bauer Sumpio
7 Diabetic Foot Infections: Microbiology
and Antibiotic Therapy .............................................................. 93
Brian Scully
8 Arterial Imaging .......................................................................... 103
Rodney P. Bensley and Marc L. Schermerhorn
9 The Role of Endovascular Therapy in Peripheral
Arterial Disease ........................................................................... 119
Andrew J. Meltzer and James F. McKinsey
10 Surgical Treatment of Infrainguinal Occlusive
Disease in Diabetes ...................................................................... 133
Shant M. Vartanian and Michael S. Conte
11 Managing Complications of Vascular Surgery
and Endovascular Therapy ........................................................ 149
Salvatore T. Scali and Timothy C. Flynn
12 Diabetes and Lower Extremity Amputation ............................ 167
Roman Nowygrod and Nii-Kabu Kabutey
13 Diabetic Considerations in Cerebrovascular Disease .............. 181
Christine Chung, Sharif Ellozy, Michael L. Marin,
and Peter L. Faries
ix