Endovascular treatment of diabetic foot in a selected population of patients with below-the-knee disease: is the angiosome model effective?
OBJECTIVE
To evaluate the efficacy of percutaneous transluminal angioplasty (PTA) in a selected population of diabetic patients with below-the-knee (BTK) disease and to analyze the reliability of the angiosome model.


METHODS
We made a retrospective analysis of the results of PTA performed in 201 diabetic patients with BTK-only disease treated at our institute from January 2005 to December 2011. We evaluated the postoperative technical success, and at 1, 6, and 12 months' follow-up, we assessed the rates and values of partial and complete ulcer healing, restenosis, major and minor amputation, limb salvage, and percutaneous oximetry (TcPO2) (Student's t test). We used the angiosome model to compare different clinicolaboratory outcomes in patients treated by direct revascularization (DR) from patients treated with indirect revascularization (IR) technique by Student's t test and the χ(2) test.


RESULTS
At a mean ± standard deviation follow-up of 17.5 ± 12 months, we observed a mortality rate of 3.5 %, a major amputation rate of 9.4 %, and a limb salvage rate of 87 % with a statistically significant increase of TcPO2 values at follow-up compared to baseline (p < 0.05). In 34 patients, treatment was performed with the IR technique and in 167 by DR; in both groups, there was a statistically significant increase of TcPO2 values at follow-up compared to baseline (p < 0.05), without statistically significant differences in therapeutic efficacy.


CONCLUSIONS
PTA of the BTK-only disease is a safe and effective option. The DR technique is the first treatment option; we believe, however, that IR is similarly effective, with good results over time.
Department of Diagnostic and Interventional Radiology, "Maggiore della Carità" Hospital, University of Eastern Piedmont "Amedeo Avogadro", C.so Mazzini 18, 28100 Novara, NO, Italy. rfossaceca@hotmail.com
Rita
R
Fossaceca
Giuseppe
G
Guzzardi
Paolo
P
Cerini
Claudio
C
Cusaro
Alessandro
A
Stecco
Giuseppe
G
Parziale
Marco
M
Perchinunno
Marco
M
De Bonis
Alessandro
A
Carriero
D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D017130:Angioplasty; D017719:Diabetic Foot / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D023821:Limb Salvage / Q000379:methods; D008297:Male; D010092:Oximetry; D011183:Postoperative Complications / Q000401:mortality; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014945:Wound Healing