"There is an amputation every 30 seconds in diabetic patients, and at a conservative estimate, 50% of these amputations were probably preventable. This situation is unacceptable," he said.
In the UK, the rate of amputations was highest among two patient groups; those with diabetes and those with non-diabetic atherosclerosis, he said. Additionally, he said that patients sometimes did not get access to a distal bypass, even when they were in hospital. "Essentially, patients who get a distal bypass can save the leg, whereas those that don’t could lose it," he said.
Iris Baumgartner’s (Berne, Switzerland) presentation was titled "No rise in the rate of major amputations in Switzerland". She said the proportion of patients subjected to vascular evaluation and intervention has increased, and this revascularisation had direct bearing on the number of amputations. Baumgartner emphasised the importance of a well functioning vascular service as part of the multidisciplinary approach.
"The actual rate of major amputation in Europe is still unknown, but it is expected to increase. The factors influencing major amputation rates are not limited to treatment, but include reimbursement, awareness and education," she said.
Hans-Henning Eckstein, Munich, Germany called for a "mandatory" interdisciplinary approach in the treatment for diabetes related foot complications. He made it a point to invite participants to the next ilegx meeting in Munich.
Eckstein said initiatives to improve diabetic foot complications included the development national guidelines for the diagnosis , treatment and prevention of diabetic foot complications, disease managemnt programmes, certification of diabetic centres by the German Society for Diabetology and certification of vascular centres by the German Society for Vascular Surgery.
Post-lunch, Frank Veith, New York, USA, told an overflowing audience that he was amongst the first people to push for limb salvage surgery and aggressively use both distal bypass and percutaneous transluminous angioplasty in limb salvage. "Other surgeons doubted us and thought our aggressive limb salvage approach was crazy," he said.
Currently, critical limb ischaemia, is now cared for by endocompetent vascular surgeons,interventional radiologists, and interventional cardiologists. " As the technology improves, more than 85% of procedures for critical limb isachaemia will be catheter-based. As many procedures will be very distal and difficult, redo procedures will often be required," he said.
Dieter Mayer, Zurich, Switzerland, who is one of the chairmen for the session, called for a single champion who would take charge of wound care. Gunnar Tepe, a co-chair on the Best of ilegx @CX, emphasised that amputation should not be done before imaging with Magnetic Resonance Angiography or Digital Subtraction Angiography.
ilegx aims for the early diagnosis of all the underlying causes of leg/foot tissue loss. It promotes interdisciplinary collaboration which spans the acute and community services.
The next ilegx conference, analysing the continental challenges in leg/foot tissue loss will be held in Munich, Germany from 13-14 October 2009.
