Healing of Diabetic Neuroischemic Foot Wounds With vs Without Wound-Targeted Revascularization: Preliminary Observations From an 8-Year Prospective Dual-Center Registry. - 2020
Healing of Diabetic Neuroischemic Foot Wounds With vs Without Wound-Targeted Revascularization: Preliminary Observations From an 8-Year Prospective Dual-Center Registry.
[en] Purpose: To assess the clinical efficacy of endovascular angiosome-oriented wound-targeted revascularization (WTR) vs indirect (wound-indifferent) revascularization (IR) in diabetic patients with neuroischemic foot ulcers. Materials and Methods: Between April 2009 and July 2017, 167 diabetic patients (mean age 72.8 years; 137 men) with chronic limb-threatening ischemia (Rutherford category 5) and foot wounds (Wagner 2-4) in 194 limbs were prospectively registered and scheduled for primary infragenicular endovascular treatment. Specific angiosome source artery reperfusion sustained by patent foot arches or arterial-arterial connections was attempted initially. If this approach failed, topographic revascularization via available collaterals (WTRc) and IR were sequentially attempted. Results: Reperfusion was successful in 176 (91%) of 194 limbs (113 with WTR, 28 with WTRc, and 35 with IR); the global angiosome-oriented technical success (WTR and WTRc) was 73% (141/194). The mean follow-up was 10.9±0.7 months (range 3-12.5). Over 1 year, 102 (58%) of the 176 successfully treated limbs experienced wound healing [79/113 (70%) in the WTR group, 15/28 (54%) in the WTRc group, and 7/35 (20%) in the IR group; p=0.011]. The mean time to healing was 6.8±0.4 months in the WTR group, 7.9±0.6 months in the WTRc group, and 9.8±0.7 months in the IR group (p=0.001). Relapses were noted in 18 (16%) WTR limbs, 5 (18%) WTRc limbs, and 6 (17%) IR limbs. Comparison between WTR and IR and WTRc vs IR showed improved cicatrization in the angiosome-oriented groups (p<0.05). Major adverse limb events (MALE) and limb salvage were different between WTR and WTRc and between WTR and IR groups (p<0.05), while WTRc vs IR was not. Amputation-free survival was not influenced by the revascularization strategy (p=0.093). Conclusion: Wound healing in diabetic patients with chronic limb-threatening ischemia appeared to be improved by intentional wound-targeted revascularization, but no uniform benefit concerning MALE or limb preservation was observed. IR still represents an alternative for limb salvage in cases in which angiosome-guided revascularization fails.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
ALEXANDRESCU, Vlad-Adrian ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie cardio-vasculaire et thoracique ; Department of Vascular Surgery, Princess Paola Hospital, Marche-en-Famenne, Belgium
Brochier, Sophie; Department of Diabetology, Princess Paola Hospital, Marche-en-Famenne, Belgium
Limgba, Augustin; Department of Surgery, Princess Paola Hospital, Marche-en-Famenne, Belgium
Balthazar, Severine; Department of Anesthesiology, Princess Paola Hospital, Marche-en-Famenne, Belgium
Khelifa, Hafid ; Université de Liège - ULiège > Département des sciences cliniques ; Department of Intensive Care, Princess Paola Hospital, Marche-en-Famenne, Belgium
De Vreese, Pierrick; Department of Anesthesiology, Princess Paola Hospital, Marche-en-Famenne, Belgium
Azdad, Khalid; Department of Radiology, Princess Paola Hospital, Marche-en-Famenne, Belgium
Nodit, Mihaela; Department of Geriatric Care, Princess Paola Hospital, Marche-en-Famenne, Belgium
POTTIER, Morgane ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie de la main ; Department of Surgery, Princess Paola Hospital, Marche-en-Famenne, Belgium
Van Espen, Didier; Department of Orthopedic Surgery, Princess Paola Hospital, Marche-en-Famenne, Belgium
Sinatra, Tommy ; Centre Hospitalier Universitaire de Liège - CHU > > Pool ; Department of Surgery, Princess Paola Hospital, Marche-en-Famenne, Belgium
Sinatra, Tommy ; Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
Language :
English
Title :
Healing of Diabetic Neuroischemic Foot Wounds With vs Without Wound-Targeted Revascularization: Preliminary Observations From an 8-Year Prospective Dual-Center Registry.
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