title: The management of ischemic heel ulcers and gangrene in the endovascular era.
abstract: BACKGROUND
  The objective of this study was to compare the outcome of patients presenting with heel ulcers or gangrene (HEEL group) with those having lesions in other parts of the foot (non-HEEL group).
  
  
  METHODS
  Treatment and outcomes of all HEEL and non-HEEL patients between June 2001 and October 2006 were compared.
  
  
  RESULTS
  Three hundred eight patients were treated (71 HEEL and 237 non-HEEL). The HEEL group was more frequently nonambulatory, had lower albumin levels, and had gangrene. The primary amputation rate (11% vs 3%, P < .001) was higher in HEEL patients, and more endovascular interventions were also performed in the HEEL group (75% vs 55%, P = .015). The 24-month limb salvage and patency rates were similar; but survival was worse in HEEL patients. Serum albumin <3 g/dL, dialysis dependence, and gangrene were associated with limb loss in the HEEL group. Mean time to healing was 4.3 +/- 3.4 months.
  
  
  CONCLUSIONS
  Patients with ischemic heel ulcers or gangrene were more likely to undergo primary amputation; however, limb salvage rates were similar to those of non-HEEL patients after attempted salvage. Endovascular interventions currently play a significant role in the management of these patients. Gangrene, serum albumin <3 g/dL, and dialysis dependence resulted in increased limb loss in patients with ischemic heel lesions.
authors.affiliation: Division of Vascular Surgery, Veterans Administration Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY 14215, USA. dosluoglu@yahoo.com
authors.forename: Hasan H
authors.initials: HH
authors.lastname: Dosluoglu
authors.forename: Bashir
authors.initials: B
authors.lastname: Attuwaybi
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Cherr
authors.forename: Linda M
authors.initials: LM
authors.lastname: Harris
authors.forename: Maciej L
authors.initials: ML
authors.lastname: Dryjski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D005260:Female; D016523:Foot Ulcer / Q000473:pathology / Q000601:surgery*; D005734:Gangrene; D006365:Heel / Q000098:blood supply* / Q000473:pathology; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D014656:Vascular Surgical Procedures