The Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS) was founded on October 1st 2018 to enhance cooperation amongst vascular professionals within Mediterranean countries. Due to its prominent social and economic impact on national health systems, diabetic arteriopathy has been selected as the very first topic to be investigated by the Federation. METHODS: MeFAVS members were asked to reply to a questionnaire on the management of diabetic ischemic foot. Results were collected and analyzed statistically. The questionnaire consisted of 15 multiple choice answers regarding diabetic foot diagnosis and treatment. The questionnaire was submitted to 21 centers on April 20th, 2019. RESULTS: Response rate was 62%. The survey revealed that vascular surgeons, diabetologists and wound care nurses made up the core of Diabetic Teams present in 76.9, 69.3 and 92.3% of the centers, respectively. Diabetic Teams were most often led by vascular surgeons (53.8%) and diabetologists (42.2%) but only in 7.9% of cases by nurses. Duplex ultrasonography (DUS) and computed tomographic angiography (CTA) were the most commonly available tools used to assess diabetic peripheral arterial disease (PAD). Surgical wound care was undertaken by vascular surgeons in the majority of cases, and only in 46.2% of the cases to orthopedic or plastic surgeons while non-surgical wound care was handled by specialized nurses (76.6%) and diabetologists (53.8%). First-line revascularization was preferred over conservative treatment (61.5 vs. 53.8%) and endovascular strategy (45.3%) over open (33.7%) or hybrid (21.0%) surgery. Vascular surgeons and interventional radiologists were found to be the most common performers of endovascular revascularization (92.3 and 53.8%, respectively). Amputations had an overall rate of 16.6% (range 4-30%) and a mean reintervention rate of 22.5% and were usually performed by vascular surgeons for both minor and major interventions (84.6%) followed by orthopedic surgeons (15.4% minor, 30.8% major). The availability of a diabetic foot clinic (84.6%) and endovascular (53.8%) and open surgery (46.2%) capabilities were considered fundamental in order to reduce amputation rates. CONCLUSIONS: Especially since the introduction and spreading of new endovascular techniques for the treatment of diabetic foot, it is a common consensus amongst vascular surgeons that a standardized approach to the discipline is necessary in order to improve outcomes such as amputation-free survival and mortality. In this perspective and purpose that transnational cooperation amongst vascular professionals and residents in training are aiming for greater proficiency in endovascular and open surgery.
Managing peripheral artery disease in diabetic patients: a questionnaire survey from vascular centers of the Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS)
Castelli, PatrizioMembro del Collaboration Group
;Tozzi, MatteoMembro del Collaboration Group
;
2019-01-01
Abstract
The Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS) was founded on October 1st 2018 to enhance cooperation amongst vascular professionals within Mediterranean countries. Due to its prominent social and economic impact on national health systems, diabetic arteriopathy has been selected as the very first topic to be investigated by the Federation. METHODS: MeFAVS members were asked to reply to a questionnaire on the management of diabetic ischemic foot. Results were collected and analyzed statistically. The questionnaire consisted of 15 multiple choice answers regarding diabetic foot diagnosis and treatment. The questionnaire was submitted to 21 centers on April 20th, 2019. RESULTS: Response rate was 62%. The survey revealed that vascular surgeons, diabetologists and wound care nurses made up the core of Diabetic Teams present in 76.9, 69.3 and 92.3% of the centers, respectively. Diabetic Teams were most often led by vascular surgeons (53.8%) and diabetologists (42.2%) but only in 7.9% of cases by nurses. Duplex ultrasonography (DUS) and computed tomographic angiography (CTA) were the most commonly available tools used to assess diabetic peripheral arterial disease (PAD). Surgical wound care was undertaken by vascular surgeons in the majority of cases, and only in 46.2% of the cases to orthopedic or plastic surgeons while non-surgical wound care was handled by specialized nurses (76.6%) and diabetologists (53.8%). First-line revascularization was preferred over conservative treatment (61.5 vs. 53.8%) and endovascular strategy (45.3%) over open (33.7%) or hybrid (21.0%) surgery. Vascular surgeons and interventional radiologists were found to be the most common performers of endovascular revascularization (92.3 and 53.8%, respectively). Amputations had an overall rate of 16.6% (range 4-30%) and a mean reintervention rate of 22.5% and were usually performed by vascular surgeons for both minor and major interventions (84.6%) followed by orthopedic surgeons (15.4% minor, 30.8% major). The availability of a diabetic foot clinic (84.6%) and endovascular (53.8%) and open surgery (46.2%) capabilities were considered fundamental in order to reduce amputation rates. CONCLUSIONS: Especially since the introduction and spreading of new endovascular techniques for the treatment of diabetic foot, it is a common consensus amongst vascular surgeons that a standardized approach to the discipline is necessary in order to improve outcomes such as amputation-free survival and mortality. In this perspective and purpose that transnational cooperation amongst vascular professionals and residents in training are aiming for greater proficiency in endovascular and open surgery.
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