Impact of pedal arch revascularization on clinical outcomes of diabetic patients with critical limb ischemia

Abstract

Aim The aim was to evaluate the effect of pedal arch revascularization in diabetic patients suffering from critical limb ischemia (CLI) on wound healing, time to heal, and limb salvage. Materials and methods The study was carried out from March 2016 to February 2019 at Sohag University Hospitals on 60 diabetic patients diagnosed with CLI. Pedal arch revascularization was combined with traditional management. Patients were divided into complete pedal arch (CPA), incomplete pedal arch (IPA), and absent pedal arch (APA) groups. Wound healing, time to heal, limb salvage, and freedom from minor amputations were evaluated and compared among the patient groups. Results The patients were classified into CPA group (15 patients, 25%), IPA (26 patients, 43.3%), and APA group (19 patients, 31.7%). There were no statistical difference between groups in age, sex, or risk factors. CPA patients showed a significantly higher rate of wound healing and shorter time-to-heal than other patient groups, 93.3% in CPA, 73.1% in IPA, and 52.6% in the APA group (P=0.003). Time to heal was 3.4±2.5 months in CPA patients, 4.0±2.9 in IPA, and 6.1±3.2 in APA group (P=0.02). Limb salvage rate was significantly better in CPA patients (100% in CPA, 88.5% in IPA, and 68.4% in APA group; P=0.01). Freedom from minor amputation was 86.6, 76.9, and 47.4% (P=0.086) in CPA, IPA, and APA group, respectively. Conclusion Pedal arch patency has a positive clinical impact on wound healing rate, time to heal, and limb salvage in the management of diabetic patients with CLI undergoing endovascular intervention.