Effectiveness of revascularization of the ulcerated foot in diabetic patients with peripheral artery disease for one year follow-up

Abstract

BACKGROUND: Diabetes is an important risk factor for atherosclerosis. The diabetic foot is characterized by the presence of arteriopathy and neuropathy.When ischemia is diagnosed, restoration of pulsatile blood flow by revascularization may be considered for salvaging the limb. The treatment options are angioplasty with or without stenting and surgical bypass or hybrid procedures combining the two.

AIMS: To evaluate the outcomes of severe ischemic diabetic foot ulcers for which percutaneous transluminal angioplasty (PTA) was considered as the first-line vascular procedure. Factors associated with successful PTA were also evaluated.

METHODS: In 80 consecutive diabetic patients with foot ulcers and severe limb ischemia, PTA was performed if feasible. All patients were followed until healing or for one year. Clinical and angiographic factors in fluencing outcomes after PTA were sought by univariate and multivariate analysis.

RESULTS: PTA was done in 73 of the 80 (91.2%) patients, and considered clinically succe ssful in 58(79.9%). Successful PTA was significantly higher in patients with Superficial femoral artery, posterior Tibialis and dorsalis pedis arteries involvement in the univariate analysis. Seven patients were expired during the study follow up due to MI, pulmonary thromboembolism and GI bleeding.

CONCLUSION: PTA in diabetic patients with severe ischemic foot ulcers provided favorable. Some parameters could be used for predicting PTA successfulness.

Keywords

percutaneous transluminal angioplasty / revascularization / diabetes

References

[1] Esteghamati A, Larijani B, Aghajani M H, Ghaemi F, Kermanchi J, Shahrami A, Saadat M, Esfahani E N, Ganji M, Noshad S, Khajeh E, Ghajar A, Heidari B, Afarideh M, Mechanick J I, Ismail-Beigi F (2017). Diabetes in Iran: Prospective Analysis from First Nationwide Diabetes Report of National Program for Prevention and Control of Diabetes (NPPCD-2016). Sci Rep, 7(1): 13461

[2] Faglia E, Clerici G, Clerissi J, Caminiti M, Quarantiello A, Curci V, Losa S, Vitiello R, Lupattelli T, Somalvico F (2008). Angioplasty for diabetic patients with failing bypass graft or residual critical ischemia after bypass graft. Eur J Vasc Endovasc Surg, 36(3): 331–338

[3] Flu H C, Lardenoye J H, Veen E J, Aquarius A E, Van Berge Henegouwen D P, Hamming J F (2009). Morbidity and mortality caused by cardiac adverse events after revascularization for critical limb ischemia. Ann Vasc Surg, 23(5): 583–597

[4] Forman D E, Berman A D, McCabe C H, Baim D S, Wei J Y (1992). PTCA in the elderly: the “young-old” versus the “old-old”. J Am Geriatr Soc, 40(1): 19–22

[5] Gottsäter A (2006). Managing risk factors for atherosclerosis in critical limb ischaemia. Eur J Vasc Endovasc Surg, 32(5): 478–483

[6] Jörneskog G (2012). Why critical limb ischemia criteria are not applicable to diabetic foot and what the consequences are. Scand J Surg, 101(2): 114–118

[7] Kassaian S E, Mohajeri-Tehrani M R, Dehghan-Nayyeri A, Saroukhani S, Annabestani Z, Alidoosti M, Shirani S, Shojaei-Fard A, Molavi B, Poorhosseini H, Salarifar M, Aboee-Rad M, Pashang M, Larijani B (2013). Major adverse events, six months after endovascular revascularization for critical limb ischemia in diabetic patients. Arch Iran Med, 16(5): 258–263

[8] Kota S K, Kota S K, Meher L K, Sahoo S, Mohapatra S, Modi K D (2013). Surgical revascularization techniques for diabetic foot. J Cardiovasc Dis Res, 4(2): 79–83

[9] Lepäntalo M, Apelqvist J, Setacci C, Ricco J B, de Donato G, Becker F, Robert-Ebadi H, Cao P, Eckstein H H, De Rango P, Diehm N, Schmidli J, Teraa M, Moll F L, Dick F, Davies A H (2011). Chapter V: Diabetic foot. Eur J Vasc Endovasc Surg, 42(Suppl 2): S60–S74

[10] Markakis K, Bowling F L, Boulton A J (2016). The diabetic foot in 2015: an overview. Diabetes Metab Res Rev, 32(Suppl 1): 169–178

[11] Norgren L, Hiatt W R, Dormandy J A, Nehler M R, Harris K A, Fowkes F G, the TASC II Working Group (2007). Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg, 45(1 Suppl S): S5–S67

[12] Lumsden A B, Davies M G, Peden E K ( 2009). Medical and endovascular management of critical limb ischemia. J Endo Ther, 16(2_suppl): 31–62

[13] Sakai A, Hirayama A, Adachi T, Nanto S, Hori M, Inoue M, Kamada T, Kodama K (1996). Is the presence of hyperlipidemia associated with impairment of endothelium-dependent neointimal relaxation after percutaneous transluminal coronary angioplasty? Heart Vessels, 11(5): 255–261

[14] Salas C A, Adam D J, Papavassiliou V G, London N J (2004). Percutaneous transluminal angioplasty for critical limb ischaemia in octogenarians and nonagenarians. Eur J Vasc Endovasc Surg, 28(2): 142–145

[15] Sun N F, Tian A L, Tian Y L, Hu S Y, Xu L (2013). The interventional therapy for diabetic peripheral artery disease. BMC Surg, 13(1): 32

[16] Uccioli L, Gandini R, Giurato L, Fabiano S, Pampana E, Spallone V, Vainieri E, Simonetti G (2010). Long-term outcomes of diabetic patients with critical limb ischemia followed in a tertiary referral diabetic foot clinic. Diabetes Care, 33(5): 977–982

[17] Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y (2017). Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis ^†. Ann Med, 49(2): 106–116

Acknowledgments

We wish to thank all our colleagues in Razi Hospital, Ahvaz, Iran.

Compliance with ethical standards

The authors declared no conflict of interest. All procedures have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was signed prior to participation in the study.

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