title: Early revascularization after admittance to a diabetic foot center affects the healing probability of ischemic foot ulcer in patients with diabetes.
abstract: OBJECTIVE
  There is limited information about whether time from recognition of decreased perfusion to revascularization affects the probability of healing in a patient with a diabetic foot ulcer. The aim of the present study was to examine whether time to revascularization after referral to a multidisciplinary foot center was related to the outcome of foot ulcers in patients with diabetes and severe peripheral arterial disease (PAD).
  
  
  METHODS
  Patients with diabetes, a foot ulcer, and a systolic toe pressure <45 mmHg or an ankle pressure <80 mmHg were prospectively included at the foot center, and considered for revascularization according to a preset protocol. All patients underwent invasive revascularization, either percutaneous transluminal angioplasty (PTA) or reconstructive vascular surgery. All patients had continuous follow-up until healing or death irrespective of the type of revascularization.
  
  
  RESULTS
  A total of 478 patients were included (age 74 [range 66-80] years, 60% males), of whom 315 patients (66%) had PTA, and 163 (34%) had reconstructive surgery. Of the 478 patients, 217 (45%) healed primarily, 88 (19%) healed after a minor amputation, 76 (16%) healed after a major amputation and 92 patients (19%) died unhealed. The median time from inclusion in the study to revascularization was 8 weeks (3-18 weeks). Time to vascular intervention within 8 weeks (p < .001), maximum Wagner grade reached <3 (p < .001), absence of peripheral edema (p = .033), and presence of intermittent claudication (p = .001) were related to a higher probability of healing.
  
  
  CONCLUSIONS
  Time to revascularization and extent of tissue damage were related to the probability of healing of ischemic foot ulcer in patients with diabetes over time. In the presence of a decreased perfusion in a patient with diabetes and a foot ulcer not only revascularization per se but also timing of revascularization is important for the possibility of healing without a major amputation.
authors.affiliation: Department of Endocrinology, Skåne University Hospital, Malmö, Sweden. Electronic address: Targ.Elgzyri@med.lu.se.
authors.forename: T
authors.initials: T
authors.lastname: Elgzyri
authors.affiliation: Department of Orthopaedic Surgery, Skåne University Hospital, Lund, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Larsson
authors.affiliation: Department of Occupational Medicine, Skåne University Hospital, Lund, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Nyberg
authors.affiliation: Department of Surgery, Helsingborg's Hospital, Helsingborg, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Thörne
authors.affiliation: Vascular Department, Skåne University Hospital, Malmö, Sweden.
authors.forename: K-F
authors.initials: KF
authors.lastname: Eriksson
authors.affiliation: Department of Endocrinology, Skåne University Hospital, Malmö, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Apelqvist
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D000800:Angioplasty, Balloon / Q000379:methods; D017719:Diabetic Foot / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010343:Patient Admission; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D014945:Wound Healing
keywords: Diabetes; Foot ulcer; Time to revascularization