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. (C) 2019 Elsevier B.V. All rights reserved.

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 [10.1016/j.diabres.2019.04.031].

Below-the-ankle arterial disease severely impairs the outcomes of diabetic patients with ischemic foot ulcers

Meloni M.;Giurato L.;Gandini R.;Uccioli L.
2019-01-01

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. (C) 2019 Elsevier B.V. All rights reserved.
2019
Pubblicato
Rilevanza internazionale
Articolo
Esperti anonimi
Settore MED/13 - ENDOCRINOLOGIA
English
Amputation; Diabetes; Diabetic foot ulcers; Peripheral arterial disease; Revascularization; Aged; Aged, 80 and over; Amputation; Ankle; Ankle Joint; Cohort Studies; Diabetic Foot; Female; Humans; Ischemia; Limb Salvage; Male; Middle Aged; Peripheral Arterial Disease; Prognosis; Severity of Illness Index; Time Factors; Treatment Outcome; Wound Healing
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 [10.1016/j.diabres.2019.04.031].
Meloni, M; Izzo, V; Giurato, L; Gandini, R; Uccioli, L
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/228159
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