Aggressive endovascular approach improves diabetic foot ulcer outcomes
MedWire News: Proactive treatment of foot ulcers, including endovascular procedures, can significantly reduce the need for amputation in patients with diabetes and limb ischemia, study findings suggest.
"Treatment of critical limb ischemia very much depends on the centers to which patients are referred and this fact could determine the outcome," write Javier Aragón-Sánchez (La Paloma Hospital, Las Palmas de Gran Canaria, Spain) and co-workers in the journal Diabetic Medicine.
"As our experience using the endovascular approach for high-risk patients with complex lesions has been associated with low rates of complications and post-operative mortality, our approach is always to attempt to improve the blood flow in such patients," the investigators add.
For the current study, the authors examined the benefit of their typical aggressive approach to limb ischemia and foot ulcers in patients with diabetes.
Specifically, the researchers retrospectively reviewed data from 20 patients with diabetes, foot ulcers, and critical limb ischemia who were treated with percutaneous transluminal angioplasty.
Treatment success, defined as a residual stenosis of less than 30% with anterograde blood flow in at least one distant vessel, was seen in 19 patients. Additional surgery was necessary in eight patients, and this significantly increased the risk for infection. Limb salvage was maintained in 19 patients over long-term follow-up of 642 days, with full healing observed in 14 patients, a further four patients still healing, one major amputation and, eventually, three deaths.
Reflecting on their work, the authors say the results are possibly limited because data were collected retrospectively, a small number of patients were involved, and there was no control comparison group.
Despite this, they say this is a robust demonstration that "the management of foot ulcers, including those complicated by infection, and critical limb ischemia by means of an aggressive approach, including endovascular procedures in specialized settings, provides a high rate of limb salvage."
"This may result in lowering the number of lower limb amputations in our community," the team concludes.
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By Philip Ford