Successful Revascularization has a Significant Impact on Limb Salvage Rate and Wound Healing for Patients with Diabetic Foot Ulcers: Single-Centre Retrospective Analysis with a Multidisciplinary Approach

António Proença Caetano, Inês Conde Vasco, Filipe Veloso Gomes, Nuno Vasco Costa, José Hugo Luz, Erik Spaepen, Ana Formiga, Élia Coimbra, José Neves, Tiago Bilhim

Research output: Contribution to journalArticle

Abstract

Purpose: Analyze the impact of endovascular revascularization on major amputation rates and wound healing for patients with diabetic foot ulcers (DFUs). Materials and Methods: Single-center retrospective study from 2014–2018 including 314 patients with DFUs submitted to endovascular revascularizations. Group A—patients with a successful endovascular revascularization (n = 285; 90.8%); Group B—patients submitted to a failed attempt of endovascular revascularization (n = 29; 9.2%). Baseline data were not significantly different between the 2 groups (p > 0.05). Both groups were compared regarding: major amputation rates; wound healing, mortality and adverse events. Survival and regression analyses were used. Results: Mean follow-up time was 734.1 ± 610.2 days. Major amputation rates were 3.9% versus 24.1% (p < 0.0001) and complete wound healing was 53.7% versus 20.7% (p < 0.0001) for patients from Group A versus Group B, respectively. Major adverse events were registered in 2 patients (one from each group); minor adverse events included 10 patients from Group A and 2 patients from Group B (p = 0.3654). Major amputation rates were: 3.9% versus 27.5% at 1 year; 4.6% versus 27.5% at 2–5 years for Group A versus Group B, respectively (p < 0.0001). Survival rates were: 87.8% at 1 year; 84.4% at 2 years; and 77.9% at 5 years with no significant differences between groups. Predictors for major amputation included failed revascularization (p < 0.0001), older age (p = 0.0394), prior stroke (0.0018), dialysis (0.0476). Predictors for mortality included older age (p < 0.0001) and coronary artery disease (p = 0.0388). Conclusion: Endovascular revascularization for patients with DFUs is safe and has a significant impact on limb salvage and wound healing.

Original languageEnglish
JournalCardiovascular And Interventional Radiology
DOIs
Publication statusAccepted/In press - 2020

Keywords

  • Below-the-knee disease
  • Critical limb ischemia (CLI)
  • Diabetic foot disease
  • Diabetic foot infections
  • Diabetic foot ulcers (DFUs)
  • Diabetic foot wounds
  • Infragenicular arteries
  • Infrapopliteal arteries
  • Limb salvage
  • Major amputation
  • Percutaneous transluminal angioplasty (PTA)
  • Peripheral artery disease
  • Ulceration of the foot

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