Percutaneous transluminal angioplasty in severe diabetic foot ischemia: outcomes and prognostic factors.
OBJECTIVE
To evaluate the outcomes of severe ischemic diabetic foot ulcers for which percutaneous transluminal angioplasty (PTA) was considered as the first-line vascular procedure. Factors associated with successful PTA were sought.


METHODS
In 32 consecutive diabetic patients with foot ulcers and severe limb ischemia, PTA was performed if feasible; if not, primary bypass grafting was done when feasible. All patients were followed until healing or for at least one year. Patients with worsening ulcers after PTA underwent bypass grafting. Clinical and angiographic factors influencing outcomes after PTA were sought by univariate and multivariate analysis.


RESULTS
PTA was done in 25 of the 32 (78%) patients, and considered clinically successful in 13 (52%). After 1 year, the healing rate was 70% and the limb salvage rate 90%. Successful PTA was significantly associated with a higher post-PTA transcutaneous oxygen pressure (P = 0.03) and presence of at least one patent pedal vessel (P = 0.03) in the univariate analysis; only a patent pedal vessel was significant in the multivariate analysis.


CONCLUSIONS
Primary PTA in diabetic patients with severe ischemic foot ulcers provides similar outcomes to usual results obtained in severe ischemia in absence of diabetes. The presence of one patent pedal vessel on arteriography before PTA is the best prognostic factor.
Jacqueminet
S
S
Service de diabétologie et métabolisme, Hôpital Pitié-Salpétrière, Paris, France. jacqueminet@psl.ap-hop-paris.fr
Hartemann-Heurtier
A
A
Izzillo
R
R
Cluzel
P
P
Golmard
J L
JL
Ha Van
G
G
Koskas
F
F
Grimaldi
A
A
D000368:Aged; D000792:Angiography; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy; D017719:Diabetic Foot / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D016523:Foot Ulcer / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D008297:Male; D018579:Patient Selection; D011379:Prognosis; D012907:Smoking; D016896:Treatment Outcome; D014945:Wound Healing