The Role of Early Revascularization and Biomarkers in the Management of Diabetic Foot Ulcers: A Single Center Experience.

Ettore Dinoto,Manfredi Agostino La Marca,Giovanni Guercio,David Pakeliani,Guido Bajardi,Salvatore Evola,Marco Marcianò,Felice Pecoraro,Francesca Ferlito,Graziella Tortomasi,Francesca Urso

doi:10.3390/diagnostics12020538

Abstract

Diabetic neuropathy and Peripheral Arterial Disease (PAD) are the main etiological factors in foot ulceration. Herein, we report our experience of diabetic foot ulceration (DFU) management, with an analysis of the relationship between the rate of lower extremity amputation, in persons with infected DFU, after revascularization procedures performed to prevent major amputation. This study highlights the role of different biomarkers, showing their usefulness and potentiality in diabetic foot ulcer management, especially for the early diagnosis and therapy effectiveness monitoring. A retrospective analysis, from September 2016 to January 2021, of diabetic patients presenting diabetic foot with DFU, was performed. All patients were treated with at least one vascular procedure (endovascular, open, hybrid procedures) targeting PAD lesions. Outcomes measured were perioperative mortality and morbidity. Freedom from occlusion, primary and secondary patency, and amputation rate were registered. A total of 267 patients, with a mean age of 72.5 years, were included in the study. The major amputation rate was 6.2%, minor amputation rate was 17%. In our experience, extreme revascularization to obtain direct flow reduced the rate of amputations, with an increase in ulcer healing.

Highlights

Diabetic foot ulceration (DFU) is the most frequent endpoint of diabetic complications
The availability of sensitive biomarkers for the early diagnosis of Diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD) would be of enormous interest
The current study aims to determine the risk factors associated with lower extremity amputation in patients with infected DFU, examining the reliability of different biomarkers in different stages of the disease

Summary

Introduction

Diabetic foot ulceration (DFU) is the most frequent endpoint of diabetic complications. DFU represents a significant global medical, social and economic problem It is defined as a structural or functional alteration of the foot that may manifest as ulcers, osteomyelitis, or gangrene, as a result of the interaction of different factors, induced by sustained hyperglycemia and previous traumatic causes [1,2]. Despite the possibility to assess the main direct causes of aggressive DFU through different instrumental diagnostic methods, the difficulties related to their execution usually find a late application, when irreversible lesions are already present. In this scenario, the availability of sensitive biomarkers for the early diagnosis of DPN and PAD would be of enormous interest. These biomarkers have been tested and assessed with regards to the relationship between the rate of lower extremity amputation in persons with infected DFU, after revascularization procedures performed for the prevention of major amputation with limb salvage

Materials and Methods

Discussion

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Conclusions