Extensive use of peripheral angioplasty, particularly infrapopliteal, in the treatment of ischaemic diabetic foot ulcers: clinical results of a multicentric study of 221 consecutive diabetic subjects.
OBJECTIVE
To evaluate the feasibility, technical effectiveness and limb salvage potential of percutaneous transluminal angioplasty (PTA), particularly infrapopliteal, in diabetic subjects with ischaemic foot ulcer.


METHODS
Intervention study with PTA in consecutive series.


METHODS
Six Diabetology Foot Centres and one Cardiovascular Catheterization Laboratory in Italy.


METHODS
Two hundred and twenty-one consecutive diabetic subjects hospitalized for ischaemic foot ulcer.


METHODS
Peripheral arterial occlusive disease (PAOD) was investigated by means of foot pulses assessment, ankle-brachial-index (ABI), transcutaneous oxygen tension (TcPO2) and duplex scanning. If non-invasive parameters suggested PAOD, angiography was performed and a PTA was carried out during the same session.


METHODS
PTA feasibility, improvement of ABI and TcPO2, limb salvage rate, clinical recurrence.


RESULTS
On angiography, two patients had stenoses which were <50% of the vessel diameter. PTA was performed in 191 (85.3%) of the 219 subjects with stenoses >50%, even when longer than 10 cm and/or multiple/calcified. In 11 patients (5.8%) PTA was performed in the proximal axis exclusively, in 81 (42.4%) patients in the infrapopliteal axis exclusively and in 99 (51.8%) in both the femoropopliteal and infrapopliteal axis. Both ABI and TcPO2 improved significantly after PTA (P < 0.0001). Clinical recurrence occurred in 14 subjects: 10 of whom underwent a second successful PTA. Of the 191 patients who underwent PTA, 10 (5.2%) underwent an above-the-ankle amputation.


CONCLUSIONS
PTA, including infrapopliteal, is feasible in most diabetic subjects with ischaemic foot ulcer and is effective for foot revascularization. Clinical recurrence was infrequent and the procedure could successfully be repeated in most cases. In subjects treated successfully with PTA the above-the-ankle amputation rate was low. PTA should be considered as the revascularization treatment of first choice in all diabetic subjects with foot ulcer and PAOD.
Faglia
E
E
Internal Medicine Unit, Diabetology Centre, Policlinico Multimedica, Sesto San Giovanni, Milano, Italy. ezio.faglia@multimedica.it
Mantero
M
M
Caminiti
M
M
Caravaggi
C
C
De Giglio
R
R
Pritelli
C
C
Clerici
G
G
Fratino
P
P
De Cata
P
P
Dalla Paola
L
L
Mariani
G
G
Poli
M
M
Settembrini
P G
PG
Sciangula
L
L
Morabito
A
A
Graziani
L
L
D000368:Aged; D000671:Amputation, Surgical; D000792:Angiography; D000800:Angioplasty, Balloon / Q000009:adverse effects; D001158:Arteries / Q000601:surgery*; D017719:Diabetic Foot / Q000209:etiology / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000098:blood supply; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D007866:Leg / Q000098:blood supply; D008297:Male; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D012008:Recurrence; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome