Medial arterial calcification of dorsalis pedis artery in a diabetic foot: A poor prognostic feature

Background: Medial arterial calcification (MAC) of the tibial and pedal arteries has been associated with an increased risk of amputation among people with diabetes. Endovascular interventions on infrageniculate vessels are frequently performed with the intent of treating peripheral artery disease (PAD) and decreasing the risk of amputation in those with diabetes. This study aimed to investigate how the extent of MAC impacts outcomes of endovascular procedures in people with diabetic foot ulcers (DFU). Methods: We identified all patients who had undergone infrageniculate angioplasty in the setting of DFU at our institution between 2009 and 2019. Subjects were assigned a MAC score based on the severity of MAC in each vessel visualized on plain radiographs of the ankle and foot. We evaluated the relationship between MAC and the primary outcome, major adverse limb event (MALE), using stratified Cox proportional modeling. Results: Among 99 subjects with DFU who had undergone infrageniculate angioplasty, MALE occurred in 50% (95% confidence interval [CI] 38%-61%) of patients within 1 year of intervention. On univariate Cox regression analysis, each 1 point increment in MAC score (hazard ratio [HR], 1.09; 95% CI 1.01-1.18), the third tertile of MAC score (HR, 2.27; 95% CI 1.01-5.11), age (HR 0.96; 95% CI 0.93-0.99), and wound grade (HR, 5.34; 95% CI 2.17-13.14), were significantly associated with increased risk of MALE. On adjusted analysis stratified by wound grade, MAC score was found to be associated with MALE only in patients with a low wound grade. Conclusion: Increased severity of MAC is associated with increased risk of MALE for subjects undergoing infrageniculate angioplasty with a low wound grade. Further research is needed to better understand the complex relationships of MAC, PAD, DFU, and interventions aimed at promoting healing of DFU.

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Assessment of Diabetic Foot through the Developmental Stages of Lower Limb Abnormalities Using Ultrasound

The Eye and Foot in Diabetes ◽

10.5772/intechopen.92431 ◽

2020 ◽

Author(s):

Suresh K.S. ◽

Sukesh Kumar A.

Keyword(s):

Blood Pressure ◽

Lower Limb ◽

Diabetic Foot ◽

Developmental Stages ◽

Systolic Pressure ◽

Arterial Calcification ◽

Velocity Spectrum ◽

Transcutaneous Oxygen ◽

Peripheral Arterial ◽

Medial Arterial Calcification

A diabetic foot is one of the most serious complications of diabetes mellitus. This causes large number of lower leg amputations worldwide. Usually this disease is getting diagnosed in a very later stage. Ankle-arm index, diastolic blood pressure, fasting plasma glucose, hemoglobin A1C, high blood pressure, medial arterial calcification, nerve conduction velocity, peripheral vascular disease, systolic blood pressure, transcutaneous oxygen tension, etc. are some of the major indicators of a diabetic foot. Among these peripheral arterial abnormalities and neuropathy are the most dominant visible factors. Detection and monitoring of diabetic foot help to demonstrate the feet at risk of ulceration positively. This study reveals the various assessment methodologies of lower limb abnormalities leading to diabetic foot using ultrasound. Ultrasound is being used in various cases related to diabetic foot, from the identification of systolic pressure for the ankle brachial pressure index to the velocity analysis of hemodynamic studies. The study analyses the lower limb abnormalities and extracts the features of diabetic foot from the velocity spectrum of ultrasound Doppler scan.

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Aortoiliac and femoropopliteal lesions in patients with concomitant peripheral arterial disease and medial arterial calcification

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-2007-988963 ◽

2007 ◽

Vol 28 (S 1) ◽

Author(s):

S Crisan ◽

D Crisan ◽

S Vesa ◽

M Chirila ◽

C Pestrea ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Arterial Disease ◽

Arterial Calcification ◽

Peripheral Arterial ◽

Medial Arterial Calcification

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Effect of medial arterial calcification on O2 supply to exercising diabetic feet

Diabetes ◽

10.2337/diabetes.39.8.938 ◽

1990 ◽

Vol 39 (8) ◽

pp. 938-941 ◽

Cited By ~ 4

Author(s):

E. Chantelau ◽

X. Y. Ma ◽

S. Herrnberger ◽

C. Dohmen ◽

P. Trappe ◽

...

Keyword(s):

Arterial Calcification ◽

O2 Supply ◽

Medial Arterial Calcification

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Association of infrapopliteal medial arterial calcification with lower-limb amputations in high-risk patients: A systematic review and meta-analysis

Vascular Medicine ◽

10.1177/1358863x20979738 ◽

2020 ◽

pp. 1358863X2097973

Author(s):

Fabrizio Losurdo ◽

Roberto Ferraresi ◽

Alessandro Ucci ◽

Anna Zanetti ◽

Giacomo Clerici ◽

...

Keyword(s):

Risk Factor ◽

High Risk ◽

Lower Limb ◽

Fixed Effects ◽

Meta Analysis ◽

Arterial Calcification ◽

High Risk Patients ◽

Patients With Diabetes ◽

Risk Patients ◽

Medial Arterial Calcification

Medial arterial calcification (MAC) is a known risk factor for cardiovascular morbidity. The association between vascular calcifications and poor outcome in several vascular districts suggest that infrapopliteal MAC could be a risk factor for lower-limb amputation (LLA). This study’s objective is to review the available literature focusing on the association between infrapopliteal MAC and LLA in high-risk patients. The PubMed and Embase databases were systematically searched. We selected original studies reporting the association between infrapopliteal MAC and LLAs in patients with diabetes and/or peripheral artery disease (PAD). Estimates were pooled using either a fixed-effects or a random-effects model meta-analysis. Heterogeneity was evaluated using the Q and I2 statistics. Publication bias was investigated with a funnel plot and Egger test. The trim-and-fill method was designed to estimate the possibly missing studies. Influence analysis was conducted to search studies influencing the final result. Test of moderators was used to compare estimates in good versus non-good-quality studies. Fifteen articles satisfied the selection criteria ( n = 6489; median follow-up: 36 months). MAC was significantly associated with LLAs (pooled adjusted risk ratio (RR): 2.27; 95% CI: 1.89–2.74; I2 = 25.3%, Q-test: p = 0.17). This association was kept in the subgroup of patients with diabetes (RR: 2.37; 95% CI: 1.76–3.20) and patients with PAD (RR: 2.48; 95% CI: 1.72–3.58). The association was maintained if considering as outcome only major amputations (RR: 2.11; 95% CI: 1.46–3.06). Our results show that infrapopliteal MAC is associated with LLAs, thus suggesting MAC as a possible new marker of the at-risk limb.

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The Influence of Arterial Calcification on Clinical Outcomes in Patients with Diabetic Foot Ulcer Complicated by Osteomyelitis Treated by Surgery

The International Journal of Lower Extremity Wounds ◽

10.1177/15347346211022587 ◽

2021 ◽

pp. 153473462110225

Author(s):

Marta Carmena-Pantoja ◽

Francisco Javier Álvaro-Afonso ◽

Esther García-Morales ◽

Yolanda García-Álvarez ◽

Aroa Tardáguila-García ◽

...

Keyword(s):

Clinical Outcomes ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Arterial Calcification ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Time To Recurrence ◽

Artery Disease ◽

Clinical Records

The aim of our study was to analyze the influence of radiographic arterial calcification (RAC) on clinical outcomes and wound healing in patients with diabetic foot ulcers complicated by osteomyelitis treated by surgery. We analyzed retrospectively the clinical records of 102 patients with diabetic foot osteomyelitis who underwent surgery at a specialized diabetic foot unit between January 2014 and December 2016. The clinical data of evolution until its complete epithelialization and a follow-up 1 year were reviewed, and after reviewing the radiological images, patients were classified into 2 groups: those with RAC and those without RAC. We analyzed several clinical features in both groups. The presence of RAC was associated with a greater time of healing (10.68 ± 7.24 vs 8.11 ± 4.50 weeks; P = .029) and shorter time to recurrence and reulceration (13.30 ± 9.25 vs 18.81 ± 11.63 weeks; P = .036). However, this association was not found for patients with mild and moderate peripheral artery disease (PAD), whose time of healing was 8.97 ± 4.51 weeks compared to 9.16 ± 6.39 weeks for patients without PAD; P = .864. The time of healing of diabetic foot ulcers complicated by osteomyelitis treated by surgery can be negatively affected by the presence of RAC even more than by the presence of mild and moderate ischemia. The presence of RAC may offer clinical guidance at the level of primary care though this would need thorough validation in future studies.

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