Vascular surgical treatment of multimorbid patients with diabetic foot syndrome (DFS)

Diabetic foot syndrome (DFS) is the most common cause of major amputation in Germany. Most foot lesions are caused by repetitive pressure loading in the presence of diabetic polyneuropathy. Peripheral artery disease (PAD) prevents wound healing and is the main risk factor for amputations. In these cases, prompt revascularization is crucial. The use of endovascular and vascular surgical methods depends on the distribution pattern and length of the occlusive processes, with the procedures complementing each other. The choice of procedure is also based on the perioperative or interventional risk of the often old, multimorbid patients. Age itself is not an exclusion criterion, but in very old DFS patients, the situation often arises that due to numerous previous treatments, there is no anatomical or technical possibility of revascularization ("no option"), or that these patients are simply too sick for complex procedures ("too sick"). Multidisciplinary centers offering revascularization for DFS can achieve improvement in arterial blood flow in 90% of cases and reduce amputation rates by up to 80%. Because of the high recurrence rate of diabetic foot lesions, measures for secondary prophylaxis are of outstanding importance. These include regular follow-up examinations of the feet, the provision of adequate footwear and insoles, and competent podiatric and orthopedic care. Surgical correction of foot and toe deformities to prevent recurrent ulcers can support long-term vascular medical outcomes.