Effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral artery disease: a systematic review.
Symptoms or signs of peripheral artery disease (PAD) can be observed in up to 50% of the patients with a diabetic foot ulcer and is a risk factor for poor healing and amputation. In 2012, a multidisciplinary working group of the International Working Group on the Diabetic Foot published a systematic review on the effectiveness of revascularization of the ulcerated foot in patients with diabetes and PAD. This publication is an update of this review and now includes the results of a systematic search for therapies to revascularize the ulcerated foot in patients with diabetes and PAD from 1980 to June 2014. Only clinically relevant outcomes were assessed. The research conformed to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and Scottish Intercollegiate Guidelines Network methodological scores were assigned. A total of 56 articles were eligible for full-text review. There were no randomized controlled trials, but there were four nonrandomized studies with a control group. The major outcomes following endovascular or open bypass surgery were broadly similar among the studies. Following open surgery, the 1-year limb salvage rates were a median of 85% (interquartile range of 80-90%), and following endovascular revascularization, these rates were 78% (70-89%). At 1-year follow-up, 60% or more of ulcers had healed following revascularization with either open bypass surgery or endovascular techniques. Studies appeared to demonstrate improved rates of limb salvage associated with revascularization compared with the results of conservatively treated patients in the literature. There were insufficient data to recommend one method of revascularization over another. There is a real need for standardized reporting of baseline demographic data, severity of disease and outcome reporting in this group of patients.
St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK.
R J
RJ
Hinchliffe
St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK.
J R W
JR
Brownrigg
Amputation Prevention Center, Valley Presbyterian Hospital, Los Angeles, CA, USA.
G
G
Andros
Department of Endocrinology, University Hospital of Malmö, Malmö, Sweden.
J
J
Apelqvist
Seattle Epidemiologic Research and Information Centre, Department of Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, WA, USA.
E J
EJ
Boyko
Vascular Surgery, The University of Adelaide, Adelaide, South Australia, Australia.
R
R
Fitridge
Michael E. Debakey Department of Surgery, Baylor College of Medicine, Houston, USA.
J L
JL
Mills
Department of Vascular Radiology, Amsterdam Medical Centre, Amsterdam, The Netherlands.
J
J
Reekers
Department of Vascular Surgery, Southampton University Hospitals NHS Trust, Southampton, UK.
C P
CP
Shearman
Department of Surgery, University of Washington, Seattle, WA, USA.
R E
RE
Zierler
Division Endocrinology, MUMC+, CARIM Institute, Maastricht, The Netherlands.
N C
NC
Schaper
D000671:Amputation, Surgical / Q000009:adverse effects; D017130:Angioplasty / Q000009:adverse effects / Q000639:trends; D003925:Diabetic Angiopathies / Q000150:complications; D017719:Diabetic Foot / Q000150:complications / Q000534:rehabilitation / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000639:trends; D019317:Evidence-Based Medicine; D005528:Foot / Q000098:blood supply / Q000601:surgery; D006801:Humans; D023821:Limb Salvage / Q000009:adverse effects* / Q000639:trends; D057285:Precision Medicine; D035703:Therapies, Investigational / Q000009:adverse effects* / Q000639:trends; D058017:Vascular Grafting / Q000009:adverse effects* / Q000639:trends; D014945:Wound Healing
amputation; diabetes; diabetic foot; peripheral artery disease; ulcer