Lo ZJ, Lin Z, Pua U, Quek LHH, Tan BP, Punamiya S, Tan GWL, Narayanan S, Chandrasekar S, et al.
Annals of vascular surgery. Date of publication 2018 May 1;volume 49():9-16.
1. Ann Vasc Surg. 2018 May;49:9-16. doi: 10.1016/j.avsg.2018.01.061. Epub 2018 Feb
9.
Diabetic Foot Limb Salvage-A Series of 809 Attempts and Predictors for
Endovascular Limb Salvage Failure.
Lo ZJ(1), Lin Z(2), Pua U(3), Quek LHH(3), Tan BP(3), Punamiya S(3), Tan GWL(4),
Narayanan S(4), Chandrasekar S(4).
Author information:
(1)Vascular Surgery Service, Department of General Surgery, Tan Tock Seng
Hospital, Singapore. Electronic address: zhiwen@gmail.com.
(2)University Surgical Cluster, National University Health System, Singapore.
(3)Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan
Tock Seng Hospital, Singapore.
(4)Vascular Surgery Service, Department of General Surgery, Tan Tock Seng
Hospital, Singapore.
BACKGROUND: To review patient characteristics and outcomes of in-patient diabetic
foot limb salvage and identify risk factors predicting for endovascular limb
salvage failure.
METHODS: Retrospective study of limb salvage attempts in 809 patients between
August 2013 and July 2015.
RESULTS: Sixty-eight percent of our study population were male with mean age at
65 years and 73% presented with Rutherford grade 6 critical limb ischemia, with
the remaining 27% Rutherford grade 5. Eighty-one percent had toe pressures of
less than 50 mm Hg, 64% had infrainguinal trans-Atlantic inter-society consensus
(TASC II) C or D lesions while 78% had infrapopliteal TASC II C or D lesions.
Seven hundred seventy-seven patients (96%) underwent endovascular-first approach
limb salvage, with 95% requiring infrapopliteal angioplasty, with 84% of them
requiring 2-vessel or 3-vessel revascularization. Thirty-two patients (4%)
underwent surgical bypass limb salvage, with 63% performed as salvage procedures
for failed angioplasties. The mean in-patient stay was 12.3 days within the
endovascular group and 31.1 days within the bypass group (P < 0.01). One-year
limb salvage was successful in 88% of endovascular group, as compared with 72% in
bypass group (P = 0.01). Overall 1-year survival was 93% within the endovascular
group and 88% within the bypass group (P = 0.27). The mean in-patient cost was
SGD$5,518 within the endovascular group and SGD$15,141 within the bypass group
(P < 0.01). Multivariate analysis showed that independent predictors for failure
of endovascular limb salvage include end-stage renal failure (ESRF) (odds ratio
[OR] 2.04, P = 0.01), toe pressures <50 mm Hg (OR 2.15, P = 0.01), infrainguinal
TASC II patterns C or D (OR 1.99, P = 0.03), and indirect angiosome
revascularization (OR 2.03, P = 0.02).
CONCLUSIONS: Within our study population of Asian ethnicity, most in-patient
diabetic foot peripheral arterial disease presented with Rutherford grade 6
disease, with mostly TASC II C or D lesions and required infrapopliteal
revascularization. As most patients had multiple comorbidities and were poor
surgical candidates, the majority underwent endovascular-first approach
revascularization. Independent predictors of endovascular limb salvage failure
include ESRF, toe pressures <50 mm Hg, infrainguinal TASC II patterns C or D, and
indirect angiosome revascularization.
Copyright © 2018 Elsevier Inc. All rights reserved.
DOI: 10.1016/j.avsg.2018.01.061
PMID: 29428535 [Indexed for MEDLINE]
