糖尿病にともなう血管疾患
糖尿病による血管病変として最も重要なものが閉塞性動脈硬化症である．神経性潰瘍を生じる糖尿病性足病変との鑑別は重要で，虚血の有無を早急に診断する必要がある．閉塞性動脈硬化症では糖尿病が合併することでより一層重症化しやすく，下肢切断に至ることも稀ではない．糖尿病の早期からの適切なコントロールの必要性はもちろんのことだが，潰瘍壊死症例では早急に血行再建を行わなければならず，長期的な予後も考慮して積極的な外科治療を適切に行うことが血管外科医には求められている．...
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| Published in | 日本血管外科学会雑誌 Vol. 32; no. 2; pp. 105 - 109 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本血管外科学会
23.03.2023
日本血管外科学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0918-6778 1881-767X |
| DOI | 10.11401/jsvs.23-00001 |
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| Abstract | 糖尿病による血管病変として最も重要なものが閉塞性動脈硬化症である．神経性潰瘍を生じる糖尿病性足病変との鑑別は重要で，虚血の有無を早急に診断する必要がある．閉塞性動脈硬化症では糖尿病が合併することでより一層重症化しやすく，下肢切断に至ることも稀ではない．糖尿病の早期からの適切なコントロールの必要性はもちろんのことだが，潰瘍壊死症例では早急に血行再建を行わなければならず，長期的な予後も考慮して積極的な外科治療を適切に行うことが血管外科医には求められている． |
|---|---|
| AbstractList | 要旨:糖尿病による血管病変として最も重要なものが閉塞性動脈硬化症である. 神経性潰瘍を生じる糖尿病性足病変との鑑別は重要で, 虚血の有無を早急に診断する必要がある. 閉塞性動脈硬化症では糖尿病が合併することでより一層重症化しやすく, 下肢切断に至ることも稀ではない. 糖尿病の早期からの適切なコントロールの必要性はもちろんのことだが, 潰瘍壊死症例では早急に血行再建を行わなければならず, 長期的な予後も考慮して積極的な外科治療を適切に行うことが血管外科医には求められている. 糖尿病による血管病変として最も重要なものが閉塞性動脈硬化症である．神経性潰瘍を生じる糖尿病性足病変との鑑別は重要で，虚血の有無を早急に診断する必要がある．閉塞性動脈硬化症では糖尿病が合併することでより一層重症化しやすく，下肢切断に至ることも稀ではない．糖尿病の早期からの適切なコントロールの必要性はもちろんのことだが，潰瘍壊死症例では早急に血行再建を行わなければならず，長期的な予後も考慮して積極的な外科治療を適切に行うことが血管外科医には求められている． |
| Author | 駒井, 宏好 |
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| References | 9) Iida O, Takahara M, Soga Y, et al.; SPINACH Investigators. Three-year outcomes of surgical versus endovascular revascularization for critical limb ischemia: the SPINACH study (surgical reconstruction versus peripheral intervention in patients with critical limb ischemia). Circ Cardiovasc Interv 2017; 10: e005531. 14) Herraiz-Adillo Á, Cavero-Redondo I, Álvarez-Bueno C, et al. The accuracy of toe brachial index and ankle brachial index in the diagnosis of lower limb peripheral arterial disease: a systematic review and meta-analysis. Atherosclerosis 2020; 315: 81–92. 25) Farber A, Menard MT, Conte MS, et al.; BEST-CLI Investigators. Surgery or endovascular therapy for chronic limb-threatening ischemia. N Engl J Med 2022; 387: 2305–2316. 24) Sorber R, Dun C, Kawaji Q, et al. Early peripheral vascular interventions for claudication are associated with higher rates of late interventions and progression to chronic limb threatening ischemia. J Vasc Surg 2022; 77: 836–847.e3. 23) Iida O, Soga Y, Kawasaki D, et al. Angiographic restenosis and its clinical impact after infrapopliteal angioplasty. Eur J Vasc Endovasc Surg 2012; 44: 425–431. 20) Hap K, Biernat K, Konieczny G. Patients with diabetes complicated by peripheral artery disease: the current state of knowledge on physiotherapy interventions. J Diabetes Res 2021; 2021: 5122494. 17) Lam K, van Asten SA, Nguyen T, et al. Diagnostic accuracy of probe to bone to detect osteomyelitis in the diabetic foot: a systematic review. Clin Infect Dis 2016; 63: 944–948. 16) Yamamoto N, Sakashita H, Miyama M, et al. Evaluation of perfusion index as a screening tool for developing critical limb ischemia. Ann Vasc Dis 2021; 14: 328–333. 26) Hoshino J, Ubara Y, Ohara K, et al. Changes in the activities of daily living (ADL) in relation to the level of amputation of patients undergoing lower extremity amputation for arteriosclerosis obliterans (ASO). Circ J 2008; 72: 1495–1498. 8) 日本血管外科学会JCLIMB委員会，NCD JCLIMB分析チーム．JAPAN Critical Limb Ischemia Database（JCLIMB）年次報告集計（2013年～2016年）．日血外会誌2019; 28: 219–247. 12) Uchimoto S, Tsumura K, Hayashi T, et al. Impact of cigarette smoking on the incidence of type 2 diabetes mellitus in middle-aged Japanese men: the Osaka Health Survey. Diabet Med 1999; 16: 951–955. 18) Ohkubo Y, Kishikawa H, Araki E, et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract 1995; 28: 103–117. 15) Kimura T, Watanabe Y, Tokuoka S, et al. Utility of skin perfusion pressure values with the Society for Vascular Surgery Wound, Ischemia, and foot Infection classification system. J Vasc Surg 2019; 70: 1308–1317. 2) IDF Clinical Practice Recommendations on the Diabetic Foot-2017: A guide for healthcare professionals. https://www.idf.org/e-library/guidelines/119-idf-clinical-practice-recommendations-on-diabetic-foot-2017.html（参照：2023年1月10日） 4) Criqui MH, Aboyans V. Epidemiology of peripheral artery disease. Circ Res 2015; 116: 1509–1526. 3) Buso G, Aboyans V, Mazzolai L. Lower extremity artery disease in patients with type 2 diabetes. Eur J Prev Cardiol 2019; 26 2_suppl: 114–124. 7) Yamazaki T, Goto S, Shigematsu H, et al.; The REACH Registry Investigators. Prevalence, awareness and treatment of cardiovascular risk factors in patients at high risk of atherothrombosis in Japan. Circ J 2007; 71: 995–1003. 19) Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS35): prospective observational study. BMJ 2000; 321: 405–412. 6) Selvin E, Marinopoulos S, Berkenblit G, et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 2004; 141: 421–431. 22) Azuma N, Uchida H, Kokubo T, et al. Factors influencing wound healing of critical ischaemic foot after bypass surgery: is the angiosome important in selecting bypass target artery? Eur J Vasc Endovasc Surg 2012; 43: 322–328. 13) Krempf M, Parhofer KG, Steg PG, et al.; Reach Registry Investigators. Cardiovascular event rates in diabetic and nondiabetic individuals with and without established atherothrombosis (from the REduction of Atherothrombosis for Continued Health [REACH] Registry). Am J Cardiol 2010; 105: 667–671. 5) Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD); TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg 2000; 31: S1–S296. 11) Matsushita K, Ballew SH, Coresh J, et al.; Chronic Kidney Disease Prognosis Consortium. Measures of chronic kidney disease and risk of incident peripheral artery disease: a collaborative meta-analysis of individual participant data. Lancet Diabetes Endocrinol 2017; 5: 718–728. 21) Armstrong DG, Lavery LA; Diabetic Foot Study Consortium. Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet 2005; 366: 1704–1710. 1) Ogurtsova K, da Rocha Fernandes JD, Huang Y, et al. IDF Diabetes Atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract 2017; 128: 40–50. 10) Wolf G, Müller N, Busch M, et al. Diabetic foot syndrome and renal function in type 1 and 2 diabetes mellitus show close association. Nephrol Dial Transplant 2009; 24: 1896–1901. |
| References_xml | – reference: 3) Buso G, Aboyans V, Mazzolai L. Lower extremity artery disease in patients with type 2 diabetes. Eur J Prev Cardiol 2019; 26 2_suppl: 114–124. – reference: 10) Wolf G, Müller N, Busch M, et al. Diabetic foot syndrome and renal function in type 1 and 2 diabetes mellitus show close association. Nephrol Dial Transplant 2009; 24: 1896–1901. – reference: 1) Ogurtsova K, da Rocha Fernandes JD, Huang Y, et al. IDF Diabetes Atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract 2017; 128: 40–50. – reference: 12) Uchimoto S, Tsumura K, Hayashi T, et al. Impact of cigarette smoking on the incidence of type 2 diabetes mellitus in middle-aged Japanese men: the Osaka Health Survey. Diabet Med 1999; 16: 951–955. – reference: 13) Krempf M, Parhofer KG, Steg PG, et al.; Reach Registry Investigators. Cardiovascular event rates in diabetic and nondiabetic individuals with and without established atherothrombosis (from the REduction of Atherothrombosis for Continued Health [REACH] Registry). Am J Cardiol 2010; 105: 667–671. – reference: 9) Iida O, Takahara M, Soga Y, et al.; SPINACH Investigators. Three-year outcomes of surgical versus endovascular revascularization for critical limb ischemia: the SPINACH study (surgical reconstruction versus peripheral intervention in patients with critical limb ischemia). Circ Cardiovasc Interv 2017; 10: e005531. – reference: 21) Armstrong DG, Lavery LA; Diabetic Foot Study Consortium. Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet 2005; 366: 1704–1710. – reference: 25) Farber A, Menard MT, Conte MS, et al.; BEST-CLI Investigators. Surgery or endovascular therapy for chronic limb-threatening ischemia. N Engl J Med 2022; 387: 2305–2316. – reference: 22) Azuma N, Uchida H, Kokubo T, et al. Factors influencing wound healing of critical ischaemic foot after bypass surgery: is the angiosome important in selecting bypass target artery? Eur J Vasc Endovasc Surg 2012; 43: 322–328. – reference: 11) Matsushita K, Ballew SH, Coresh J, et al.; Chronic Kidney Disease Prognosis Consortium. Measures of chronic kidney disease and risk of incident peripheral artery disease: a collaborative meta-analysis of individual participant data. Lancet Diabetes Endocrinol 2017; 5: 718–728. – reference: 19) Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS35): prospective observational study. BMJ 2000; 321: 405–412. – reference: 15) Kimura T, Watanabe Y, Tokuoka S, et al. Utility of skin perfusion pressure values with the Society for Vascular Surgery Wound, Ischemia, and foot Infection classification system. J Vasc Surg 2019; 70: 1308–1317. – reference: 18) Ohkubo Y, Kishikawa H, Araki E, et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract 1995; 28: 103–117. – reference: 17) Lam K, van Asten SA, Nguyen T, et al. Diagnostic accuracy of probe to bone to detect osteomyelitis in the diabetic foot: a systematic review. Clin Infect Dis 2016; 63: 944–948. – reference: 7) Yamazaki T, Goto S, Shigematsu H, et al.; The REACH Registry Investigators. Prevalence, awareness and treatment of cardiovascular risk factors in patients at high risk of atherothrombosis in Japan. Circ J 2007; 71: 995–1003. – reference: 20) Hap K, Biernat K, Konieczny G. Patients with diabetes complicated by peripheral artery disease: the current state of knowledge on physiotherapy interventions. J Diabetes Res 2021; 2021: 5122494. – reference: 16) Yamamoto N, Sakashita H, Miyama M, et al. Evaluation of perfusion index as a screening tool for developing critical limb ischemia. Ann Vasc Dis 2021; 14: 328–333. – reference: 23) Iida O, Soga Y, Kawasaki D, et al. Angiographic restenosis and its clinical impact after infrapopliteal angioplasty. Eur J Vasc Endovasc Surg 2012; 44: 425–431. – reference: 24) Sorber R, Dun C, Kawaji Q, et al. Early peripheral vascular interventions for claudication are associated with higher rates of late interventions and progression to chronic limb threatening ischemia. J Vasc Surg 2022; 77: 836–847.e3. – reference: 14) Herraiz-Adillo Á, Cavero-Redondo I, Álvarez-Bueno C, et al. The accuracy of toe brachial index and ankle brachial index in the diagnosis of lower limb peripheral arterial disease: a systematic review and meta-analysis. Atherosclerosis 2020; 315: 81–92. – reference: 5) Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD); TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg 2000; 31: S1–S296. – reference: 26) Hoshino J, Ubara Y, Ohara K, et al. Changes in the activities of daily living (ADL) in relation to the level of amputation of patients undergoing lower extremity amputation for arteriosclerosis obliterans (ASO). Circ J 2008; 72: 1495–1498. – reference: 4) Criqui MH, Aboyans V. Epidemiology of peripheral artery disease. Circ Res 2015; 116: 1509–1526. – reference: 6) Selvin E, Marinopoulos S, Berkenblit G, et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 2004; 141: 421–431. – reference: 2) IDF Clinical Practice Recommendations on the Diabetic Foot-2017: A guide for healthcare professionals. https://www.idf.org/e-library/guidelines/119-idf-clinical-practice-recommendations-on-diabetic-foot-2017.html（参照：2023年1月10日）． – reference: 8) 日本血管外科学会JCLIMB委員会，NCD JCLIMB分析チーム．JAPAN Critical Limb Ischemia Database（JCLIMB）年次報告集計（2013年～2016年）．日血外会誌2019; 28: 219–247. |
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| Snippet | ... 要旨:糖尿病による血管病変として最も重要なものが閉塞性動脈硬化症である. 神経性潰瘍を生じる糖尿病性足病変との鑑別は重要で, 虚血の有無を早急に診断する必要がある. 閉塞性動脈硬化症では糖尿病が合併することでより一層重症化しやすく, 下肢切断に至ることも稀ではない.... |
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| SubjectTerms | 糖尿病 糖尿病足病変 血管病 閉塞性動脈硬化症 |
| Title | 糖尿病にともなう血管疾患 |
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