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患者，女，76岁，因“反复双足溃烂、感染，发现血糖、血压升高8+年，加重伴左足拇趾、3、4及5趾坏疽1+月” 入院。20个月前患者被诊断为“慢性肾脏病G5A3”，给予规律血液透析治疗。本次入院后左下肢及足X线平片检查示左侧股浅动脉、腘动脉、胫前动脉、胫后动脉、足背动脉、趾动脉钙化，跖骨远端溶骨性破坏，第4、5趾外侧脱位。双下肢动脉彩超示双侧股浅动脉中膜钙化明显，左侧腘动脉血栓形成，左侧胫前动脉重度狭窄、胫后动脉闭塞；右侧胫前、胫后动脉闭塞。双下肢动脉CT血管造影术（CTA）显示左股浅动脉中度狭窄，左腘动脉闭塞，左胫后动脉、左足背动脉闭塞；右胫后动脉重度狭窄、闭塞。诊断为糖尿病足（左4级），糖尿病下肢动脉闭塞症（左4期）。入院行多学科协作团队（MDT）讨论，患者不能行血管旁路治疗，建议左下肢截肢术。但超声心动图检查示右心房占位，诊断“血液透析导管相关右心房血栓”，不宜行截肢手术，建议保守治疗。基于此，给予硫酸氢氯吡格雷片抗血小板聚集，依诺肝素纳注射液、华法林纳片抗凝，脂微球前列地尔注射液扩血管等治疗，同时积极给予局部清创及超声清创水刀治疗9周，但是足部情况未见明显好转。第10周起，给予创面负压吸引及自体富血小板凝胶治疗，创面有所缩小；第17周，局部给予“0.5%马来酸噻吗洛尔” 1滴/cm2治疗，6周后创面基本愈合，随访5周，创面完全愈合，患者未诉不适。这是第1例联合应用自体富血小板凝胶及β受体阻滞剂，成功治愈难治性缺血性糖尿病足溃疡的报道。“,”History and clinical findings A 76 year-old woman with 8-year history of diabetes mellitus and hypertension was admitted with gangrene of left great toe, 3rd, 4th and 5th toes. Twenty months ago, She started to receive hemodialysis due to end-stage renal disease. She did not have any history of reactive airway disease nor bradycardia that would contraindicate the use of topical beta-blocker. The X-ray of left lower limb and foot showed calcification of left superficial femoral artery, popliteal artery, anterior tibial artery, posterior tibial artery, dorsal foot artery and digital artery, as well as osteolytic destruction at distal end of metatarsal bone, and lateral dislocation of the 4th and 5th toes. Color Doppler ultrasound of bilateral lower extremity arteries showed obvious calcification of bilateral superficial femoral arteries, thrombosis of left popliteal artery, severe stenosis of left anterior tibial artery, occlusion of left posterior tibial artery, right anterior tibial artery and posterior tibial artery. Computed tomographic angiography (CTA) of bilateral lower limb arteries revealed moderate stenosis of left superficial femoral artery, occlusion of left popliteal artery, left posterior tibial artery and dorsal pedal artery, occulusion of right posterior tibial artery, but right dorsal pedal artery was visible. Diagnosis, treatment and follow-upDiagnosis of diabetic foot (left, grade 4) and diabetic lower extremity arterial occlusion (left, stage 4) was made. Based on multidisciplinary team (MDT) discussion, the patient was unable to undergo vascular bypass surgery, and left lower extermity amputation also was not suitable because of right atrial thrombosis. Therefore, conservative treatment was recommended. The specific scheme used clopidogrel for antiplatelet agglutination, Low Molecular Weight Heparin (Clexane) and warfarin for anticoagulation, lipo-alprostadil for vasodilation, as well as local debridement and ultrasonic debridement. The treatments were given for up to 9 weeks, but with no significant clinical response. So the patient was treated with vacuum-assisted closure and autologous platelet-rich gel therapy for the next 7 weeks, then applied with 1 drop of timolol maleate 0.5% ophthalmic solution per cm2 wound area every other day for another 6 weeks, the wound rapidly healed and re-epithelialized basically. The follow-up for 5 weeks showed that the wound healed completely without any discomfort. No side effect was found.