Improved Foot Salvage Through Pedal Bypasses and Pedal Arch Angioplasty

Abstract

Aggressive pedal arch angioplasty and pedal bypasses have both been used as revascularization methods in the treatment of patients with ischemic diabetic foot. The aim of this research was to evaluate the outcomes of both modalities. A retrospective analysis was done of all revascularization procedures for ischemic diabetic foot patients at King's College Hospital. Only patients who underwent pedal bypass (dorsalis pedis artery plantar artery) were included, as were patients who underwent pedal arch angioplasty. Primary, primary assisted, and secondary patency rates along with 30-day mortality, major amputation rate, amputation-free survival, and overall survival at 1 year were analyzed. Kaplan-Meier survival analysis was used as appropriate (GraphPad Prism 6.0). During the study period, 51 patients underwent pedal bypasses or pedal arch angioplasty. Median age was 72 years (range 46-90), and the male-to-female ratio was 8:1. Comorbidities included diabetes mellitus (90%), hypertension (75%), end-stage renal disease (30%), and ischemic heart disease (30%). Primary, primary assisted, and secondary patency rates were 67%, 83%, and 86% respectively. With no 30-day mortality, 1-year amputation-free survival was 85%, and 1-year overall survival was 90%. The major amputation rate was 4%. This study showed that pedal bypasses and pedal arch angioplasty have excellent outcomes at 1 year. The two modalities complement each other and help prevent amputations and save lives.