Amputation-Free Survival in Patients With Diabetes Mellitus and Peripheral Arterial Disease With Diabetic Foot Ulcer: Open Versus Endovascular Surgery

Abstract

Introduction: The number of people with diabetes mellitus (DM) is increasing worldwide with an estimated number of 422 million adults, according to WHO. The incidence of peripheral arterial disease (PAD) increases with both age and diabetes mellitus which in turn can lead to diabetic foot ulcers (DFU). Comparison of endovascular surgery vs open vascular surgery, in patients with DM, PAD and DFU has not been done in a randomized trial. Large cohort studies are therefore needed to address this issue. Methods: Between the years 1984-2006, 1151 limbs presented with DFU were admitted to a multidisciplinary foot centre. Among 1151 limbs, 478 went through vascular intervention, data on death and amputation was recorded up to 2019-01-01. Patients receiving hybrid intervention were excluded and because of loss of follow up the final study population was comprised to 408 limbs. Among the study population, 40% were women and the median follow up time was 2.7 years. Median time to intervention was 8.3 weeks. Retrospective comparative analysis between endovascular and open vascular surgery was performed. Results: Patients were treated with endovascular surgery first (n=289) or open vascular surgery first (n=119). Major amputation rate at 3 years was 17.0% and 16.8%, respectively (p=0.97) Mortality at 3 years was 42.6% and 46.2%, respectively (p=0.50). Compared to the endovascular group, patients in the open group had a lower ankle-brachial index (ABI) (p< 0.01), and there was a trend for higher HbA1c (p=0.08) and longer time to intervention (p=0.06). In a Cox regression analysis, no difference between endovascular surgery compared to open vascular surgery was found in regard to major amputation (p=0.62), mortality (p=0.23) or amputation-free survival (p=0.21). Longer time to intervention was associated with increased major amputation rate in the cox regression analysis (p=0.03). Conclusion: Endovascular sugary and open vascular surgery achieved similar long-term results in a large cohort of patients undergoing revascularization with foot ulcer, DM and PAD. Disclosure: Nothing to disclose