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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]
Appears in following Topics:
Diabetic Foot Ulcer Associated with Ischemia - Management