Diabetic Foot Angioplasty in Lucknow

Years of high blood sugar damage the lining of the arteries, and fatty plaque and calcium build up inside them. In diabetes the narrowing often affects the long, thin arteries below the knee, which leaves the foot short of blood. Doctors call this peripheral arterial disease.

Diabetes also damages the nerves of the foot, a problem called neuropathy. Cuts, blisters and pressure sores can then go unnoticed. A wound with a poor blood supply heals slowly or not at all, and infection can take hold. Smoking, raised blood pressure and high cholesterol make the artery problem worse.

• A wound or ulcer on the toe, heel or foot that is not healing after a few weeks of proper care.
• Pain in the calf on walking that eases when you stop.
• Pain in the foot at night, eased by hanging the leg over the edge of the bed.
• A cold, pale or bluish foot, shiny skin or loss of hair on the toes.
• A toe turning dark.

Neuropathy can hide pain, so the absence of pain does not mean the foot is safe. Show any foot sore to a doctor early.

Assessment begins with a foot examination, a check of the pulses and your sugar and kidney reports. The next step is usually a Colour Doppler scan of the leg arteries, which shows where flow is reduced and how severe the narrowing is.

The treating team may add ankle and toe blood pressure readings. In diabetes, stiff calcified arteries can make an ankle reading look falsely normal, so doctors rely on several tests together.

If a procedure is being considered, an angiogram gives the map. It is a set of pictures taken while contrast dye, a liquid that shows up on imaging, runs through the arteries. It may be done as a CT angiogram or as a catheter angiogram, which can be followed straight away by treatment. We do not have a CT or MRI scanner, so if your doctor wants one, they will advise where to have it done, and we can review the images.

Angioplasty opens a narrowed artery by inflating a small balloon inside it. The skin is numbed, and a thin needle enters an artery, often in the groin and sometimes at the ankle or foot. A fine wire is passed across the narrowing under live imaging, and a balloon follows on the wire.

The balloon is inflated for a short time to press the plaque against the artery wall, and then it is removed. Sometimes a small mesh tube, called a stent, or a drug-coated balloon is used to help keep the artery open. A final dye picture shows whether blood now flows down to the foot. The team carrying out the procedure explains beforehand whether you will be numbed only or lightly sedated as well.

Angioplasty restores blood flow, but the wound still needs its own treatment. Opening an artery does not clear an infection, take pressure off the sole or lower your blood sugar. Those depend on the wound care, antibiotics, footwear and diabetes plan that go alongside.

Your diabetes doctor, a vascular or foot surgeon, the wound-care team and the radiologist each see a different part of the problem. They weigh angioplasty against bypass surgery, against medicines and wound care alone, and against removing dead tissue. In some feet the tissue cannot be saved, and the team will explain that plainly if it applies.

We review your referral, scans and reports first. Whether the angioplasty is carried out at our centre or elsewhere, and by which doctor, is confirmed only after that review, together with your own treating team.

When the arteries open, more blood reaches the foot and a wound has a better chance of healing. It is not a cure for diabetes or for the artery disease, and the narrowing can return, so follow-up scans are usually needed.

Each of these is discussed with you before you consent.

• Bleeding, bruising or a swelling called a pseudoaneurysm where the needle entered the artery.
• A tear in the artery wall, or a small piece of plaque or clot travelling down to the foot.
• Allergy to the contrast dye, and extra strain on the kidneys. People with diabetes are more prone to the kidney strain, so kidney function is checked first.
• The artery narrowing again, or a stent blocking, which may need another procedure.
• Infection at the puncture site, or no improvement in the wound despite a technically good result.
• In some people the foot cannot be saved even after the artery has been opened.

Good foot care and steady blood sugar protect the result of angioplasty. High sugar slows healing and weakens the body's defence against infection, so keep to the diet, medicines and checks your diabetes doctor has set. Tests such as HbA1c, kidney function and cholesterol, which are part of our diabetic package, help the team plan.

• Look at both feet every day, including the soles and between the toes. Use a mirror or ask someone to help.
• Wash with lukewarm water, dry well between the toes, and moisturise dry heels but not the gaps between the toes.
• Never walk barefoot, even indoors. Wear well-fitting shoes and check inside them for stones or rough seams before putting them on.
• Do not cut corns or calluses yourself, and do not put hot water bottles or heating pads on your feet.
• Stop smoking if you smoke, and take the antiplatelet, cholesterol and blood pressure medicines that your doctor has prescribed.