title: Severity of demographic and clinical characteristics, revascularization feasibility, major amputation, and mortality rate in diabetic patients admitted to a tertiary diabetic foot center for critical limb ischemia: comparison of 2 cohorts recruited at a 10-year distance.
abstract: BACKGROUND
  To compare demographic and clinical characteristics, revascularization, major amputation, and mortality among patients admitted to a diabetic foot center because of critical limb ischemia (CLI) during 1999-2003 (cohort 1) and 2009 (cohort 2).
  
  
  METHODS
  During 1999-2003, 564 diabetic patients with CLI (cohort 1) were admitted to our center, and 344 patients (360 affected limbs) were admitted during 2009 (cohort 2). Data on demographic and clinical characteristics, revascularization by peripheral angioplasty (PTA) or bypass graft (BPG), major amputation, and mortality were recorded.
  
  
  RESULTS
  Patients belonging to cohort 2 were older than patients of cohort 1 (P = 0.001). In cohort 2, there were more subjects requiring insulin (P = 0.008) and duration of diabetes was longer (P = 0.001); moreover, there were more patients requiring dialysis (P = 0.001), patients with history of stroke (P = 0.004), or foot ulcer (P = 0.001). No significant difference between the 2 groups was found concerning gender, metabolic control, hypertension, lipid values, neuropathy, and retinopathy. Occlusion was more frequent than stenosis in the posterior tibial (P < 0.001) and peroneal (P = 0.016) arteries. However, the revascularization rate did not differ (P = 0.318) between the 2 groups. Restenosis after PTA was not significantly different (P = 0.627), whereas BPG failure was significantly more frequent (P = 0.010) in cohort 2 (2009). Major amputation (P = 0.222) and mortality rate (P = 0.727) did not differ between the 2 groups.
  
  
  CONCLUSIONS
  The severity of either foot lesions or patients comorbidities should be concomitantly assessed and taken into proper consideration when evaluating changes in the amputation rate among different studies or in different temporal settings.
authors: Fondazione Onlus DeaMedica, Pagani, Salerno, Italy.
authors: Ezio
authors: E
authors: Faglia
authors: Diabetic Foot Centre, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy. Electronic address: giacomoclericimd@me.com.
authors: Giacomo
authors: G
authors: Clerici
authors: Diabetic Foot Centre, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
authors: Alessia
authors: A
authors: Scatena
authors: Diabetic Foot Centre, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
authors: Maurizio
authors: M
authors: Caminiti
authors: Diabetic Foot Centre, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
authors: Vincenzo
authors: V
authors: Curci
authors: Fondazione Onlus DeaMedica, Pagani, Salerno, Italy.
authors: Marco
authors: M
authors: Prisco
authors: Fondazione Onlus DeaMedica, Pagani, Salerno, Italy.
authors: Vincenzo
authors: V
authors: Prisco
authors: Fondazione Onlus DeaMedica, Pagani, Salerno, Italy.
authors: Rosaria
authors: R
authors: Greco
authors: Diabetic Foot Centre, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
authors: Francesco
authors: F
authors: Cetta
authors: Medical Statistics Unit, Milan University, Milan, Italy.
authors: Alberto
authors: A
authors: Morabito
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D017130:Angioplasty; D019917:Blood Vessel Prosthesis Implantation; D015331:Cohort Studies; D015897:Comorbidity; D017719:Diabetic Foot / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000401:mortality* / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D008297:Male; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome