Proximal Arterial Inflow Revascularization Improves Pedal Arch Quality and Its Impact on Ischemic Diabetic Foot Ulcer Healing

Abstract

Arterial perfusion is a key factor in diabetic foot ulcer (DFU) healing. Although it is associated with pedal arch patency, not all patients are amenable to pedal artery angioplasty. This study aims to determine the impact of angiographic improvement of the pedal arch quality after proximal arterial inflow revascularization (PAIR) and its association with wound healing. One hundred and fifty diabetic patients with tissue loss in 163 limbs who had digital subtraction angiography were studied. Cox regression analysis was used to determine independent predictors of wound healing. Wound healing rates in association with pedal arch patency were calculated by Kaplan-Meier analysis. End-stage renal disease, minor amputation, and complete pedal arch patency were significant independent predictors of wound healing following PAIR with hazard ratios for failure: 3.02 (P=0.008), 0.54 (P=0.023), and 0.40 (P=0.039), respectively. The prevalence of complete pedal arches increased by 24.1% with successful intervention (P<0.001). The overall rates of wound healing at 6, 12, and 24months were 36%, 64%, and 72%, respectively. The wound healing rate at 1year in patients with a complete pedal arch was 73% compared to 45% in those with an absent pedal arch (P=0.017). PAIR increases complete pedal arch patency, a significant predictor of wound healing in DFU.