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Below-the-ankle arterial disease severely impairs the outcomes of diabetic patients with ischemic foot ulcers.
Diabetes Res Clin Pract. 2019 Jun; 152:9-15.DR

Abstract

AIM

To evaluate the impact of below-the-ankle (BTA) arterial disease in people with ischemic diabetic foot ulcers (DFUs).

METHODS

Patients with ischemic DFUs treated by a pre-set limb salvage protocol including peripheral revascularization were included. They were divided in two groups according to the involvement of BTA arteries (BTA+) or not (BTA-). Not healing, minor amputation, major amputation and mortality have been evaluated as primary outcome. Revascularization failure has been evaluated as secondary outcome.

RESULTS

The study group was composed of 272 patients, 120 (44.1%) belonging to BTA+ group and 152 (55.9%) to BTA-. After 1 year of follow-up the outcomes for BTA+ and BTA- were respectively: not healing (40.8 vs 17.8%, p < 0.0001), minor amputation (80.8 vs 20.4%, p < 0.0001), major amputation (18.3 vs 6.6%, p = 0.002), mortality (16.7% vs 10.5%, p = 0.001). The rate of revascularization failure was respectively 38.3 vs 11.2%, p < 0.0001. At the multivariate analysis BTA arterial disease resulted an independent predictor of not healing [OR 3.5 (CI 95% 2.3-6.1) p = 0.0001], minor amputation [OR 3.1 (1.5-5.9) p < 0.0001] and revascularization failure [OR 3.5 (1.9-6.3) p = 0.0001]. BTA+ patients with successful BTA revascularization showed lower rate of not healing (37.8 vs 89.1%) p < 0.0001, minor amputation (74.3 vs 91.3%) p = 0.002 and major amputation (8.1 vs 34.8%) p = 0.0003 in comparison to patients with unsuccessful BTA revascularization.

CONCLUSION

BTA arterial disease severely impairs the outcomes of diabetics with ischemic foot ulcers. BTA revascularization reduces the rate of not healing, minor and major amputation.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Meloni M
Diabetic Foot Unit, University of Tor Vergata, Rome, Italy. Electronic address: meloni.marco@libero.it.
Izzo V
Diabetic Foot Unit, University of Tor Vergata, Rome, Italy.
Giurato L
Diabetic Foot Unit, University of Tor Vergata, Rome, Italy.
Gandini R
Department of Interventional Radiology, University of Tor Vergata, Rome, Italy.
Uccioli L
Diabetic Foot Unit, University of Tor Vergata, Rome, Italy.

MeSH

AgedAged, 80 and overAmputation, SurgicalAnkleAnkle JointCohort StudiesDiabetic FootFemaleHumansIschemiaLimb SalvageMaleMiddle AgedPeripheral Arterial DiseasePrognosisSeverity of Illness IndexTime FactorsTreatment OutcomeWound Healing

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31078668

Citation

Meloni, Marco, et al. "Below-the-ankle Arterial Disease Severely Impairs the Outcomes of Diabetic Patients With Ischemic Foot Ulcers." Diabetes Research and Clinical Practice, vol. 152, 2019, pp. 9-15.
Meloni M, Izzo V, Giurato L, et al. Below-the-ankle arterial disease severely impairs the outcomes of diabetic patients with ischemic foot ulcers. Diabetes Res Clin Pract. 2019;152:9-15.
Meloni, M., Izzo, V., Giurato, L., Gandini, R., & Uccioli, L. (2019). Below-the-ankle arterial disease severely impairs the outcomes of diabetic patients with ischemic foot ulcers. Diabetes Research and Clinical Practice, 152, 9-15. https://doi.org/10.1016/j.diabres.2019.04.031
Meloni M, et al. Below-the-ankle Arterial Disease Severely Impairs the Outcomes of Diabetic Patients With Ischemic Foot Ulcers. Diabetes Res Clin Pract. 2019;152:9-15. PubMed PMID: 31078668.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Below-the-ankle arterial disease severely impairs the outcomes of diabetic patients with ischemic foot ulcers. AU - Meloni,Marco, AU - Izzo,Valentina, AU - Giurato,Laura, AU - Gandini,Roberto, AU - Uccioli,Luigi, Y1 - 2019/05/09/ PY - 2019/02/19/received PY - 2019/04/19/revised PY - 2019/04/30/accepted PY - 2019/5/13/pubmed PY - 2019/8/21/medline PY - 2019/5/13/entrez KW - Amputation KW - Diabetes KW - Diabetic foot ulcers KW - Peripheral arterial disease KW - Revascularization SP - 9 EP - 15 JF - Diabetes research and clinical practice JO - Diabetes Res Clin Pract VL - 152 N2 - AIM: To evaluate the impact of below-the-ankle (BTA) arterial disease in people with ischemic diabetic foot ulcers (DFUs). METHODS: Patients with ischemic DFUs treated by a pre-set limb salvage protocol including peripheral revascularization were included. They were divided in two groups according to the involvement of BTA arteries (BTA+) or not (BTA-). Not healing, minor amputation, major amputation and mortality have been evaluated as primary outcome. Revascularization failure has been evaluated as secondary outcome. RESULTS: The study group was composed of 272 patients, 120 (44.1%) belonging to BTA+ group and 152 (55.9%) to BTA-. After 1 year of follow-up the outcomes for BTA+ and BTA- were respectively: not healing (40.8 vs 17.8%, p < 0.0001), minor amputation (80.8 vs 20.4%, p < 0.0001), major amputation (18.3 vs 6.6%, p = 0.002), mortality (16.7% vs 10.5%, p = 0.001). The rate of revascularization failure was respectively 38.3 vs 11.2%, p < 0.0001. At the multivariate analysis BTA arterial disease resulted an independent predictor of not healing [OR 3.5 (CI 95% 2.3-6.1) p = 0.0001], minor amputation [OR 3.1 (1.5-5.9) p < 0.0001] and revascularization failure [OR 3.5 (1.9-6.3) p = 0.0001]. BTA+ patients with successful BTA revascularization showed lower rate of not healing (37.8 vs 89.1%) p < 0.0001, minor amputation (74.3 vs 91.3%) p = 0.002 and major amputation (8.1 vs 34.8%) p = 0.0003 in comparison to patients with unsuccessful BTA revascularization. CONCLUSION: BTA arterial disease severely impairs the outcomes of diabetics with ischemic foot ulcers. BTA revascularization reduces the rate of not healing, minor and major amputation. SN - 1872-8227 UR - https://www.unboundmedicine.com/medline/citation/31078668/Below_the_ankle_arterial_disease_severely_impairs_the_outcomes_of_diabetic_patients_with_ischemic_foot_ulcers_ DB - PRIME DP - Unbound Medicine ER -