The legs of hundreds of diabetics were saved from amputation by Rambam; General data on the spread of the disease in Israel

Only a few years ago, it was customary to amputate the legs of diabetic patients, who developed complications and infections. Since 2010, Rambam has performed 521 "foot catheterization" treatments, in order to save the feet of these patients

A message from Rambam Hospital

A dramatic increase in the number of leg catheterization operations performed at Rambam in the last two years. The treatment, which is considered relatively new, makes it possible to save the legs of many diabetics, who are facing the risk of amputation due to the complications of the disease. Since 2010, when the treatment entered Rambam, over 500 catheterizations have been performed, a figure that means saving the limbs of hundreds of patients. This week (Wednesday) was International Diabetes Day.

Diabetes damages blood vessels and causes them to clog and block blood flow to the foot. Because of this, wounds develop that cause necrosis and endanger the leg. This is why in the past it was customary to amputate the infected areas, trying to save the healthy parts of the leg if possible. Catheterization of the leg makes it possible to open the blockage of blood vessels in some of these patients, renew the blood supply to the foot, enable the healing of these wounds and prevent amputation. Since diabetes is chronic, the blockages and infections may recur in diabetic patients, but the catheterization can also be repeated again and again.

The delicate and complex skill of diabetic foot catheterization is performed by radiologists and invasive cardiologists and is present in a limited number of medical centers in the world. Dr. Igor Kogan, a senior physician in the invasive radiology unit at Rambam, and director of the complex endovascular radiology service at the medical center, has previously completed several professional training courses at the world's leading centers in the field. As part of these trainings, Dr. Kogan learned modern methods and the use of advanced equipment to treat blocked small blood vessels. The knowledge he acquired there was added to his experience and thus Dr. Kogan became one of the leading experts in Israel for the treatment of the diabetic foot, through catheterization and among the few skilled in performing the procedure in Israel.

In 2010, the number of catheterizations performed at Rambam was 122 operations, but the following year (2011), there was an increase of almost 70% in the number of treatments using leg catheterization, and it was 203 operations, performed on 100 patients. This trend was maintained this year as well, when until October 196 catheterizations were performed at Rambam, in 102 patients.

Dr. Kogan explains the increase in the number of treatments quite simply: "Today there is more awareness among doctors in hospitals, and doctors in the community. This is why we see an increase in both awareness of the disease, and diagnosis. The other side of the coin is the increase in the number of treatments. Today we treat many more patients, and as time passes, we become more skilled and better at applying the treatment. There is no doubt that we are making progress today in terms of therapeutic capacity, which allows us to treat more complex cases than those we treated in the past."

Save a leg with a conductor the thickness of a human hair
As mentioned, leg catheterization is a delicate operation that requires skill and patience. As part of the procedure, the doctors enter tiny blood vessels that are several millimeters in diameter. Using a conductor the thickness of a hair, the blockage is passed through the artery, and with the help of a balloon with a diameter of 2 to 3 millimeters, the blood vessels are expanded and the blood is allowed to flow towards the foot. Rambam implements methods that allow doctors to reach the arteries of the feet. The procedure lasts an average of two and a half hours, when during the operation the patient receives local anesthesia and anesthesia. After only one day of hospitalization, the patient is discharged home.

The blocked area in the patient's leg can be seen using the contrast material that is injected into the patient. Rambam is one of the few centers in Israel that at this stage also uses CO2 (carbon dioxide) which does not contain iodine and is therefore suitable for patients with kidney failure and those who are sensitive to iodine.

The complex endovascular radiology service operates within the invasive radiology unit at Rambam, under the direction of Dr. Amos Ofer, and as part of the medical imaging department, headed by Prof. Ahuva Angel. The service team performs the treatment in collaboration with the support of the Department of Vascular Surgery at Rambam under the direction of Prof. Aharon Hoffman. Orthopedists, plastic surgeons and endocrinologists are also involved in the treatment.

In Israel, over 300,000 people have pre-diabetes, at least 100 will develop diabetes within 5 years

Klalit Health Services is launching an initiative program to identify patients with pre-diabetes and bring them into a circle of medical follow-up and intervention. The program is based on changing lifestyle and starting preventative medication

Notice of General Health Services

In Israel, about half a million people are diagnosed with diabetes, along with over 300,000 people who are already known to be before the onset of the disease and are defined as having pre-diabetes. Without medical intervention - one in three may develop diabetes (type 2) within 5 years.

The scope of the potential patients leads 'Kalilit' to implement an intervention program based on early detection of pre-diabetic patients and their inclusion in follow-up and medical treatment to prevent or delay the onset of the disease. For this purpose, the general expanded the basket of services for these customers and will provide each patient at high risk of developing diabetes, 14 personal meetings with a dietician along with medical follow-up and additional training.

Diabetes is the only non-infectious chronic disease in the world recognized by the United Nations as a global epidemic. The spread of the disease is increasing at a dizzying rate from 30 million patients in 1985 to about 390 million patients today across the globe. It also appears from international data that too much
10 seconds a patient dies as a result of diabetes and in those 10 seconds, 2 more will be diagnosed with diabetes.

According to Dr. Niki Lieberman, head of Klalit's community medicine department, "Efforts to curb the rate of spread of the disease in Israel require innovative thinking in order to find patients at a stage where a change in lifestyle and minor medication can still delay or even prevent deterioration to the point of overt disease. Studies show that adopting healthy lifestyle habits postpones the onset of the disease and prevents late damage to target organs. According to studies, among people with pre-diabetes who changed their lifestyle, the risk of developing overt diabetes was reduced by up to 60%." Dr. Lieberman adds "People in a state of pre-diabetes feel good, they do not feel any symptoms and do not perceive themselves as having a medical problem that requires a change in lifestyle, therefore the efforts of the teams require increasing awareness of the extent of the problem and instilling the recognition that the disease can be controlled and even prevent its outbreak" .

Pre-diabetes is a condition in which the blood sugar level is high, but not yet high enough to diagnose the patient with diabetes and start medication. People diagnosed with prediabetes often suffer from hypertension and/or blood lipid disorders and have a double risk of developing cardiovascular disease.

As part of the program that will be run by 'Kalelit', every patient who is at risk of developing diabetes will be offered a fasting blood sugar test. A person who will be found with fasting sugar levels that range from
100-125 mg/dl, will be referred to a dietitian and family doctor for the purpose of receiving guidance and periodic medical follow-up. In the pre-diabetes stage, the recommendation is periodic medical follow-up and the adoption of a healthy lifestyle.

Good to know

• The risk groups for pre-diabetes include people who have first-degree relatives with diabetes, people who are overweight (BMI over 30), women who suffered from gestational diabetes or a newborn over 4 kg, and people who smoke.
• Type 1 diabetes (juvenile diabetes): makes up about 5% of all diabetes patients, usually appears at a young age and is characterized by a complete lack of insulin.
• Type 2 diabetes: makes up about 90% of all diabetes, can appear at any age, but mainly from the age of 40 and over and is characterized by impairment of insulin secretion and/or impairment of the body's ability to use it.
• Diabetes is a chronic disease, most of its effects are not felt immediately, and this fact causes the disease to be suppressed and the difficulty of accepting the need for chronic treatment sometimes until the situation worsens or reaches an irreversible stage.
• Major diabetes complications result from damage to small and large blood vessels in the body and include heart attacks, cerebrovascular events, damage to the eyes to the point of blindness, kidney damage that can lead to progressive renal insufficiency and the need for dialysis, damage to the legs and sometimes limb amputation.
• All of these can be prevented by delaying the development of overt diabetes and if it has nevertheless broken out, a careful balance of diabetes and its associated diseases including hypertension, obesity and blood lipid disorders.