Evaluation of Infrapopliteal Revascularization for Ischemic Diabetic Foot in Hemodialysis Patients

Abstract

Objective: To evaluate the outcomes of infrapopliteal revascularization for diabetic hemodialysis patients with ischemic diabetic foot. Methods: From 2017 to 2021, 250 patients with diabetic foot identified as stage C (ischemia) or D (ischemia and infection) of Texas Wound Classification underwent successful infrapopliteal surgical and endovascular revascularization at the vascular surgery department of Moulay Ismail Military Hospital in Meknes. The outcomes were retrospectively compared in hemodialyzed patients (HD group: 48 patients), and not hemodialyzed patients (not HD group: 202 patients) during the same period. Results: Outcomes were expressed as healing, major amputation, revascularization patency and mortality rate. Hemodialysis was a negative predictor of healing and a positive predictor of major amputation. Outcomes for HD and not HD groups were respectively: healing (62.5 vs 82 %), major amputation (37.5 vs 18 %). There was no significant difference in revascularization primary patency between the two groups (70 vs 73.6%). The mortality rate was higher in the HD group than in the not HD group (21 vs 10%). Conclusions: Our study shows that ischemic diabetic foot associated with hemodialysis have a bad prognosis with a higher risk of major amputation and death. Infrapopliteal revascularization with infection control should be performed to enhance the rate of limb salvage in this risk group.