Diabetic foot syndrome-vascular surgical procedures and challenges

Background Patients with diabetic foot syndrome (DFS) have an increased risk for amputation and account for 70% of all major amputations in Germany. Macrovascular complications are causal in >50% of this patient group. A central task and at the same time a challenge for vascular surgery is the revascularization of these often multimorbid, older patients to maintain the extremities. Objective The aim of the work is therefore to present (1) a practical step-by-step vascular diagnosis and (2) common vascular surgical methods for revascularization in patients with DFS and critical ischemia. Results Early vascular diagnosis and revascularization is associated with a significantly higher healing rate and lower risk of major amputation and is therefore absolutely necessary for patients with DFS and critical ischemia. Vascular surgery offers endovascular, conventional surgical and hybrid procedures for the treatment of critical ischemia in DFS from a single source, so that revascularization, if possible, is technically feasible. An "endovascular first" strategy has become established because of the older, comorbid patient population. However, conventional procedures, especially distal origin bypasses, continue to be justified due to their good long-term results. Conclusions Modern vascular surgery is an important partner in the interdisciplinary care of patients with DFS and should be involved in treatment at an early stage. Prompt vascular diagnostics and revascularization have been shown to lead to long-term preservation of the extremity.