Organisation of podiatric care in patients with critical limb ischaemia

Overview

Critical limb ischaemia (CLI) is a severe stage of peripheral artery disease, significantly heightening the risk of patient morbidity and mortality with a high risk of amputations. Critical limb ischaemia has a significantly negative effect on the patient prognosis, which is comparable to that of severe oncological diseases. The yearly mortality of CLI patients is 25%. In practice, up to 75% of patients who are treated at our vascular centre with the diagnosis of a critical limb ischaemia defect are diabetic patients suffering from diabetic foot syndrome. Cardiovascular and vascular centres in the Czech Republic provide highly specialised treatment of peripheral arterial disease. They offer a wide range of surgical, endovascular and combined procedures in the arteries of the lower extremities. However, a successful revascularisation is only one of several conditions for healing the defect in the shortest possible time. Therefore, the treatment of critical limb ischaemia and diabetic foot syndrome requires a multidisciplinary approach, with close cooperation between various specialists. The patients are therefore dispensed in the podiatric outpatient department of our vascular centre to ensure individualised care and the best conditions for healing the defect. The department’s medical staff conduct a comprehensive diagnosis of the patient with an assessment of the proportion of ischaemia, providing therapy for infections, topical wound therapy, revascularisation, offloading, ensuring patient education and coordinating examinations with other specialists. Comprehensive therapy provided by one inpatient department and by one physician ensures optimal conditions for quick and uncomplicated lower extremity wound healing, with fast intervention in the case of complications.

Keywords:
diabetic foot syndrome – critical limb ischaemia – triplex ultrasound – infection – antibiotic therapy – relief – revascularisation – dispensary