Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Impact of Pedal Arch Patency on Tissue Loss and Time to Healing in Diabetic Patients with Foot Wounds Undergoing Infrainguinal Endovascular Revascularization

  • Troisi, Nicola (Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital) ;
  • Turini, Filippo (Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital) ;
  • Chisci, Emiliano (Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital) ;
  • Ercolini, Leonardo (Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital) ;
  • Frosini, Pierfrancesco (Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital) ;
  • Lombardi, Renzo (Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital) ;
  • Falciani, Francesca (Diabetic Foot Center, Local Health Unit of Florence) ;
  • Baggiore, Cristiana (Diabetic Foot Center, Local Health Unit of Florence) ;
  • Anichini, Roberto (Diabetic Foot Center, Local Health Unit of Florence) ;
  • Michelagnoli, Stefano (Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital)
  • Received : 2017.02.22
  • Accepted : 2017.04.20
  • Published : 2018.02.01
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Abstract

Objective: To retrospectively evaluate the impact of pedal arch quality on tissue loss and time to healing in diabetic patients with foot wounds undergoing infrainguinal endovascular revascularization. Materials and Methods: Between January 2014 and June 2015, 137 consecutive diabetic patients with foot wounds underwent infrainguinal endovascular revascularization (femoro-popliteal or below-the-knee, arteries). Postprocedural angiography of the foot was used to divide the patients into the following three groups according to the pedal arch status: complete pedal arch (CPA), incomplete pedal arch (IPA), and absent pedal arch (APA). Time to healing and estimated 1-year outcomes in terms of freedom from minor amputation, limb salvage, and survival were evaluated and compared among the three groups. Results: Postprocedural angiography showed the presence of a CPA in 42 patients (30.7%), IPA in 60 patients (43.8%), and APA in 35 patients (25.5%). Healing within 3 months from the procedure was achieved in 21 patients with CPA (50%), 17 patients with IPA (28.3%), and in 7 patients with APA (20%) (p = 0.01). There was a significant difference in terms of 1-year freedom from minor amputation among the three groups (CPA 84.1% vs. IPA 82.4% vs. APA 48.9%, p = 0.001). Estimated 1-year limb salvage was significantly better in patients with CPA (CPA 100% vs. IPA 93.8% vs. APA 70.1%, p < 0.001). Estimated 1-year survival was significantly better in patients with CPA (CPA 90% vs. IPA 80.8% vs. APA 62.7%, p = 0.004). Conclusion: Pedal arch status has a positive impact on time to healing, limb salvage, and survival in diabetic patients with foot wounds undergoing infrainguinal endovascular revascularization.

Keywords

References

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