Managing Complicated Diabetic Foot Ulcers with Peripheral Arterial Disease

Abstract

Background: Diabetic foot ulcers are an issue of clinical interest as diabetes has become the leading cause of occlusive vasculopathy. The purpose of this study is to evaluate the clinical outcomes and the effect of revascularization in diabetic foot ulcers with peripheral arterial occlusive disease (PAOD).Methods: A total of 46 patients who had surgical treatment for diabetic foot ulcers were evaluated. We conducted an intergroup comparison of their baseline demographic and clinical characteristics, and also compared surgical outcomes between cases with and without PAOD, and also between cases on which revascularization had and had not been performed.Results: Major amputation was performed on 10 patients (21.7%). Minor amputation and reconstructive surgery were performed on 24 patients (52.2%) and 12 patients (26.1%), respectively. In the 19 patients (41.3%) with severe obstruction, eight patients (42.1%) underwent major amputation. In the patients without severe obstruction, two patients (7.4%) underwent major amputation. The high proportion of major amputation in patients with severe obstruction was statistically significant (P<0.01). Among the 19 patients with severe obstruction, nine (47.4%) underwent revascularization and 10 patients (52.6%) did not. In the patients who had revascularization, one patient (11.1%) had major amputation. In the patients who did not have revascularization, seven (70.0%) underwent major amputation. The low proportion of major amputation in patients undergoing revascularization was statistically significant (P=0.02).Conclusion: Results of this study demonstrate that preoperative evaluation of peripheral arterial disease and revascularization are important for reducing the risk of major amputation.