title: Diabetic Foot Infection: Preliminary Results of a Fast-Track Program with Early Endovascular Revascularization and Local Surgical Treatment.
abstract: BACKGROUND
  To demonstrate that a fast-track program consisting in early endovascular revascularization and local surgical treatment saves tissue in patients with diabetic foot infection (DFI).
  
  
  METHODS
  Between January and December 2014, 48 patients with DFI underwent early endovascular revascularization and local surgical treatment at our Diabetic Foot Center. In all cases, endovascular revascularization and local surgical treatment were performed within 1 week from the diagnosis of infection and during the same hospital stay. One-year outcomes were evaluated in terms of survival, primary patency, primary-assisted patency, secondary patency, absence of target lesion restenosis (TLR), and limb salvage.
  
  
  RESULTS
  The patients were predominantly males (34 of 48, 70.8%) with a mean age of 72.4 years (range, 51-91). The target vessel was a tibial artery in 34 cases (70.8%). Surgical treatment consisted of debridement without bone resection in 27 cases (56.2%), toe and/or ray amputation in 15 cases (31.2%), Lisfranc amputation in 2 cases (4.2%), transmetatarsal amputation in 2 cases (4.2%). In the remaining 2 cases, a leg amputation was necessary with an overall 30-day major amputation rate of 4.2%. During the follow-up (mean duration 6.9 months, range 1-12) healing of the lesions was obtained in 30 cases (62.5%). Estimated 12-month survival, primary patency, primary-assisted patency, secondary patency, absence of TLR, and limb salvage rates were 83.5%, 53.4%, 65%, 65%, 60.7%, and 86.6%, respectively.
  
  
  CONCLUSIONS
  A fast-track program consisting in early endovascular revascularization and local surgical treatment contributes to our experience in limiting amputation levels in patients with DFI. A multidisciplinary approach and adoption of diabetic foot triage are essential to achieve these outcomes.
authors.affiliation: Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy; Department of Surgery, Diabetic Foot Center, Local Health Unit of Florence, Florence, Italy. Electronic address: nicola.troisi@asf.toscana.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Troisi
authors.affiliation: Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy; Department of Surgery, Diabetic Foot Center, Local Health Unit of Florence, Florence, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Ercolini
authors.affiliation: Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy; Department of Surgery, Diabetic Foot Center, Local Health Unit of Florence, Florence, Italy.
authors.forename: Emiliano
authors.initials: E
authors.lastname: Chisci
authors.affiliation: Department of Surgery, Diabetic Foot Center, Local Health Unit of Florence, Florence, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Baggiore
authors.affiliation: Department of Surgery, Diabetic Foot Center, Local Health Unit of Florence, Florence, Italy.
authors.forename: Tania
authors.initials: T
authors.lastname: Chechi
authors.affiliation: Department of Surgery, Diabetic Foot Center, Local Health Unit of Florence, Florence, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Manetti
authors.affiliation: Department of Surgery, Diabetic Foot Center, Local Health Unit of Florence, Florence, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Del Pin
authors.affiliation: Department of Surgery, Diabetic Foot Center, Local Health Unit of Florence, Florence, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Virgili
authors.affiliation: Department of Surgery, Diabetic Foot Center, Local Health Unit of Florence, Florence, Italy.
authors.forename: Giangiuseppe Alberti
authors.initials: GA
authors.lastname: Lepri
authors.affiliation: Department of Surgery, Diabetic Foot Center, Local Health Unit of Florence, Florence, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Landini
authors.affiliation: Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy; Department of Surgery, Diabetic Foot Center, Local Health Unit of Florence, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Michelagnoli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D017719:Diabetic Foot / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014654:Vascular Patency