Overcoming ischemia in the diabetic foot: Minimally invasive treatment options

Abstract

As the global burden of diabetes is rapidly increasing, the incidence of diabetic foot ulcers is continuously increasing as the mean age of the world population increases and the obesity epidemic advances. A significant percentage of diabetic foot ulcers are caused by mixed micro and macro-vascular dysfunction leading to impaired perfusion of foot tissue. Left untreated, chronic limb-threatening ischemia has a poor prognosis and is correlated with limb loss and increased mortality; prompt treatment is required. In this review, the diagnostic challenges in diabetic foot disease are discussed and available data on minimally invasive treatment options such as endovascular revascularization, stem cells, and gene therapy are examined.

Keywords: Diabetic foot; Peripheral artery disease; Critical limb ischemia; Endovascular revascularization techniques; Gene and stem cells delivery; Hyperbaric oxygen treatment

Core Tip: Recognizing and promptly treating ischemia in patients with diabetic foot ulcers is essential for wound healing and limb salvage. A plethora of novel minimally invasive technologies and techniques are currently available, including dedicated peripheral angioplasty balloon catheters, drug-eluting stents, drug-coated balloons, angiosome-guided angioplasty, pedal arch angioplasty, and percutaneous deep vein arterialization, while research on gene and stem cell therapies is ongoing and initial data are deemed positive. Large, multicenter randomized trials specifically focused on optimizing endovascular treatment options for diabetic foot ulcers remain limited, and more high-quality, long-term, data are expected.