Foot Revascularization Avoids Major Amputation in Persons with Diabetes and Ischaemic Foot Ulcers.

Marco Meloni,Alfonso Bellia,Luigi Uccioli,Marco Doddi,Giorgio Loreni,Laura Giurato,Daniele Morosetti,Matteo Stefanini,Enrico Brocco,Roberto Gandini,Andrea Panunzi,José Luis Lazaro-Martinez,Davide Lauro

doi:10.3390/jcm10173977

Abstract

The study aims to evaluate the effectiveness of foot revascularization in persons with diabetic foot ulcers (DFUs) and below-the-ankle (BTA) arterial disease. Consecutive patients referred for a new active ischaemic DFU requiring lower limb revascularization were considered. Among those, only patients with a BTA arterial disease were included. Revascularization procedures were retrospectively analysed: in the case of successful foot revascularization (recanalization of pedal artery, or plantar arteries or both) or not, patients were respectively divided in two groups, successful foot perfusion (SFP) and failed foot perfusion (FFP). Healing, minor and major amputation at 12 months of follow-up were evaluated and compared. Eighty patients (80) were included. The mean age was 70.5 ± 10.9 years, 55 (68.7%) were male, 72 (90%) were affected by type 2 diabetes with a mean duration of 22.7 ± 11.3 years. Overall 45 (56.2%) patients healed, 47 (58.7%) had minor amputation and 13 (16.2%) major amputation. Outcomes for SFP and FFP were respectively: healing (89.3 vs. 9.1%, p < 0.0001), minor amputation (44.7 vs. 78.8%, p = 0.0001), major amputation (2.1 vs. 36.3%, p < 0.0001). Failed foot revascularization resulted an independent predictor of non-healing, minor amputation, and major amputation. Foot revascularization is mandatory to achieve healing and avoid major amputation in persons with ischaemic DFU and BTA arterial disease.

Highlights

Peripheral arterial disease (PAD) is a common complication of diabetes and can be documented approximately in 50% of persons with diabetic foot ulcers (DFUs) [1,2].PAD in diabetic people is often bilateral, distal and shows a high rate of recurrence after peripheral revascularization [3,4,5]
The involvement of infra-popliteal vessels is a specific characteristic of PAD in diabetics [6,7]. It is well known as revascularization of infrapopliteal vessels is effective to avoid major amputation in patients with ischaemic DFUs [7,8], and recanalization for as many infrapopliteal arteries as possible increases the chance of limb salvage [9]
In the case of successful foot revascularization defined by angiographic parameters or not, patients were respectively divided in two groups: successful foot perfusion (SFP) and failed foot perfusion (FFP)

Summary

Introduction

Peripheral arterial disease (PAD) is a common complication of diabetes and can be documented approximately in 50% of persons with diabetic foot ulcers (DFUs) [1,2].PAD in diabetic people is often bilateral, distal and shows a high rate of recurrence after peripheral revascularization [3,4,5]. Peripheral arterial disease (PAD) is a common complication of diabetes and can be documented approximately in 50% of persons with diabetic foot ulcers (DFUs) [1,2]. The involvement of infra-popliteal vessels (anterior tibial artery, posterior tibial artery, peroneal artery) is a specific characteristic of PAD in diabetics [6,7]. It is well known as revascularization of infrapopliteal vessels is effective to avoid major amputation in patients with ischaemic DFUs [7,8], and recanalization for as many infrapopliteal arteries as possible increases the chance of limb salvage [9]. A common involvement of below-the-ankle (BTA) arteries (plantar and pedal arteries) in patients with ischaemic DFUs has been documented [10,11]. 4.0/).

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