Role of endovascular intervention in patients with diabetic foot ulcer and concomitant peripheral arterial disease.

AIM: The aim of this study was to evaluate wound healing, major amputation and mortality in patients with diabetic foot ulcer and peripheral arterial disease (PAD), and to compare the group decided to have an endovascular intervention with groups referred to conservative treatment or to those judged as unreconstructable.

METHODS: A retrospective two-year review of all patients with diabetic foot ulcers and PAD presented at an interdisciplinary diabetic foot round 2006-2007 at Malmö University Hospital, Sweden, was performed. Independent predictive factors of insufficient ulcer healing, amputation and mortality during follow-up were analysed according to treatment decisions at the diabetic foot round.

RESULTS: A total of 135 limbs in 115 consecutive diabetic patients with foot ulcers were included. Median age was 73 years and 41% were women. During a median follow-up time of 17 months, 44% of the ulcers did not heal, 15% of the limbs underwent major amputation and 42% died. Ulcer depth with a Wagner grade ≥3 (hazard ratio [HR] 5.8; 95% confidence interval [CI] 2.6-12.9), CRP (HR 1.007; 95% CI 1.002-1.012, and impaired run-off (HR 3.0; 95% CI 1.03-8.9) were independent risk factors for incomplete wound healing. The three treatment decision groups: attempt for endovascular leg revascularization (N.=75), conservative (N.=42) and unreconstructable (N.=18) showed no significant difference in terms of wound healing, major amputation or death.

CONCLUSION: Patients with diabetic foot ulcers and concomitant PAD are at high risk for limb loss and premature death. Ulcer depth, CRP and impaired run-off are independent risk factors for incomplete wound healing. There is an apparent need for prospective controlled studies to better define the role of endovascular therapy in this subset of diabetic foot ulcer patients.