Limb salvage in diabetic patients with no-option critical limb ischemia: outcomes of a specialized center experience

Aim Infrapopliteal occlusive arterial lesions mostly characterize diabetic patients arteriopathy. Diabetic patients are prone to multiple comorbidities that make them candidates for low-invasive therapeutic options. The aim of this study was to evaluate the safety of infrapopliteal angioplasty in high-risk diabetic patients. Methods We undertook a study (retrospective study of a prospectively collected database) of all infrapopliteal endovascular revascularizations performed for critical limb ischemia in high-risk (≥3 major comorbidities) diabetic patients in our institution between 2008 and 2010. Study end points were safety, technical success rate, healing rate, overall 1-year survival, primary patency, secondary patency and limb salvage rates. Results A total of 101 high-risk diabetic patients (160 arterial lesions: 94 stenosis and 66 occlusions) underwent infrapopliteal endovascular surgery. No major adverse cardiovascular or cerebrovascular event was recorded within 30 days. Two major adverse limb events (two thromboses requiring major amputation) and seven minor adverse events were recorded. Technical and healing rates were, respectively, 83% and 78%. The 1-year survival, primary patency, secondary patency and limb salvage rates were, respectively, 86%, 67%, 83% and 84%. Conclusion Infrapopliteal angioplasty can be considered as a safe and feasible option for high-risk diabetic patients with critical limb ischemia.

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Use of Integra Dermal Regeneration Template for Limb Salvage in Diabetic Patients With No-Option Critical Limb Ischemia

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734620905741 ◽

2020 ◽

pp. 153473462090574 ◽

Cited By ~ 2

Author(s):

Luca Dalla Paola ◽

Paolo Cimaglia ◽

Anna Carone ◽

Giulio Boscarino ◽

Giuseppe Scavone

Keyword(s):

Limb Salvage ◽

Critical Limb Ischemia ◽

Group Versus ◽

Limb Ischemia ◽

Control Group ◽

Diabetic Patients ◽

Dermal Substitute ◽

End Point ◽

Dermal Regeneration Template ◽

Dermal Regeneration

We have analyzed in a retrospective study of consecutive diabetic patients affected by no-option critical limb ischemia (CLI) the efficacy of the dermal substitute Integra Dermal Regeneration Template for treatment of complicated foot lesions. The primary end point was limb salvage and 1-year amputation-free survival. The secondary end point was healing time of surgical site. Between October 2014 and October 2017, 1024 patients with diabetic foot ulcer (DFU) and CLI were admitted. In 84 patients (8.2%), there was a failure in distal revascularization with a persistent CLI after the procedure. Despite the persistent CLI, a group of 26 patients of this cohort obtained complete wound healing. Among them, 13 patients were treated with surgical debridement or open amputations and application of dermal substitute Integra Dermal Regeneration Template and the other 13 patients were treated without any dermal substitute. The Integra group healed within a mean time of 83.5 days, and the control group healed within a mean of 139 days ( P = .028). No major amputation was carried out at 1-year follow-up in the Integra group versus 15% in the control group. A conservative foot surgery or an approach with minor amputation in diabetic patients with no-option CLI may achieve limb salvage. The use of Integra Dermal Regeneration Template in patients with DFU and no-option CLI may be a useful option in a limb salvage program.

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PS126. Limb Salvage and Survival Rate After Endovascular Treatment of Infrapopliteal Artery Occlusion in Diabetic Patients With Critical Limb Ischemia

Journal of Vascular Surgery ◽

10.1016/j.jvs.2010.02.149 ◽

2010 ◽

Vol 51 (6) ◽

pp. 54S

Author(s):

Francesco Setacci ◽

Pasqualino Sirignano ◽

Francesca Iacoponi ◽

Gianmarco de Donato ◽

Emiliano Chisci ◽

...

Keyword(s):

Survival Rate ◽

Endovascular Treatment ◽

Limb Salvage ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Artery Occlusion ◽

Diabetic Patients ◽

Infrapopliteal Artery

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Procalcitonin Is a Prognostic Marker of Hospital Outcomes in Patients with Critical Limb Ischemia and Diabetic Foot Infection

Journal of Diabetes Research ◽

10.1155/2019/4312737 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Marco Meloni ◽

Valentina Izzo ◽

Laura Giurato ◽

Enrico Brocco ◽

Michele Ferrannini ◽

...

Keyword(s):

Limb Salvage ◽

Critical Limb Ischemia ◽

Diabetic Foot ◽

Univariate Analysis ◽

Limb Ischemia ◽

Major Amputation ◽

Diabetic Patients ◽

Hospital Outcomes ◽

Diabetic Foot Infection ◽

The Mean

Aim. To evaluate the prognostic role of procalcitonin (PCT) in patients with diabetic foot infection (DFI) and critical limb ischemia (CLI). Materials and Methods. The study group was composed of diabetic patients with DFI and CLI. All patients were treated according to a preset limb salvage protocol which includes revascularization, wound debridement, antibiotic therapy, and offloading. Inflammatory markers, including PCT, were evaluated at admission. Only positive values of PCT, greater than 0.5 ng/ml, were considered. Hospital outcomes were categorized as limb salvage (discharge with preserved limb), major amputation (amputation above the ankle), and mortality. Results. Eighty-six patients were included. The mean age was 67.3±11.4 years, 80.7% were male, 95.1% had type 2 diabetes, and the mean diabetes duration was 20.5±11.1 with a mean HbA1c of 67±16 mmol/mol. 66/86 (76.8%) of patients had limb salvage, 7/86 (8.1%) had major amputation, and 13/86 (15.1%) died. Patients with positive PCT baseline values in comparison to those with normal values showed a lower rate of limb salvage (30.4 versus 93.6%, p=0.0001), a higher rate of major amputation (13 versus 6.3%, p=0.3), and a higher rate of hospital mortality (56.5 versus 0%, p<0.0001). At the multivariate analysis of independent predictors found at univariate analysis, positive PCT was an independent predictor of major amputation [OR 3.3 (CI 95% 2.0-5.3), p=0.0001] and mortality [OR 4.1 (CI 95% 2.2-8.3), p<0.0001]. Discussion. Positive PCT at admission increased the risk of major amputation and mortality in hospital patients with DFI and CLI.

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