News

Diabetes is a chronic disease afflicting an increasing number of people worldwide. Foot complications are responsible for more than 1 million leg amputations every year.

Peripheral artery disease in diabetic patients is widely considered the most important factor influencing the outcome of a diabetic foot ulcer. In the next years, critical limb ischemia due to diabetic artery disease will become a major issue for vascular and endovascular operators.
The clinical manifestations of critical limb ischemia in diabetics are often correlated with neuropathy and infection: foot infection can dramatically increase the risk of amputation.
Currently no randomized control trials have been reported in the international literature directly comparing open versus endovascular revascularization in diabetic patients with critical limb ischemia. Revascularization is a key therapy in these patients because reestablishing an adequate blood supply to the wound is essential for healing avoiding a major amputation.

In this course, we will propose in the first unit a decision flow chart for choosing the best revascularization strategy in diabetic patients with critical limb ischemia. In the second unit, we will summarize our experience in endovascular treatment of diabetic critical limb ischemia, focusing on the main technical challenges in treating below-the-knee vessels.

The main goal of this Multidisciplinary School is to support clinicians to develop specific competencies in order to deal with and manage critical limb ischemia and diabetic foot disorders, to reinforce specific skills for selecting and applying appropriate revascularization techniques in critical limb ischemia treatment, tailoring the intervention according to lesion type and revascularization targets.
The increased knowledge of the clinical manifestations and pathophysiology of these diseases together with the specific interventional approaches will enable the learner to prevent delayed and incorrect diagnosis by selecting the appropriate treatment approach and to adopt well-time and patient-tailored strategies. 

At the end of this tutorial, the learner should be able to: 
- Recognize the different obstructive patterns of atherosclerotic disease in diabetic and non-diabetic patients
- Evaluate the different interventional approach in claudication and in critical limb ischemia, applying the correct revascularization strategy and pursuing the correct vascular targets
- Learn the key-points and necessary steps to establish a multidisciplinary team and a diabetic foot clinic
- Distinguish different targets in percutaneous revascularization strategy
- Learn/Perform/Practice a variety of revascularization techniques to be applied in critical limb ischemia management
- Evaluate the problem of prevention of restenosis considering the studies on below-the-knee vessel stenting and how restenosis affects wound healing

Here is the detailed index so that you have the opportunity to anticipate your course.

UNIT I : Critical Limb Ischemia in diabetic patients

Big & small vessels: the new scenario of PAD
  - Symptoms of PAD and interventional approach
  - DM & non-DM manifestations of PAD & pathophysiology of diabetic-CLI
  - Multidisciplinary approach in diabetic foot
  - The diabetic foot triage and treatment protocols
  - Angioplasty first strategy
  - Clinical cases

UNIT II : Revascularization strategy and technique in diabetic critical limb ischemia

Chapter I
Radiological study and anatomical variations of BTK & FOOT vessels
   - Radiological study
   - Anatomical variability of BTK & FOOT vessels

Chapter II
Revascularization strategy and technique
    - Targets in CLI revascularization
    - Antegrade femoral approach
    - Step-by-step approach in CTOs crossing strategy
    - Endoluminal approach
   - Subintimal approach
   - Retrograde approach
   - Acute result optimization
   - Prevention of restenosis

This Multidisciplinary school will be available for sale soon on your incathlab account!