Outcomes of Three Years of Teamwork on Critical Limb Ischemia in Patients With Diabetes and Foot Lesions

International Journal of Lower Extremity Wounds - Tập 11 Số 2 - Trang 113-119 - 2012
Alessia Scatena1, P Petruzzi2, Mauro Ferrari3, Loredana Rizzo1, Antonio Cicorelli2, Raffaella Berchiolli3, Chiara Goretti1, Irene Bargellini2, Daniele Adami3, Elisabetta Iacopi1, Andrea Del Corso3, Roberto Cioni2, Alberto Piaggesi1
1Diabetic Foot Section, Department of Medicine, Azienda Ospedaliero-Universitaria Pisana
2Section of Interventional Radiology, Imaging Department, Azienda Ospedaliero-Universitaria Pisana
3Vascular Surgery Unit, Cardiothoracic Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy

Tóm tắt

To evaluate the outcomes of a multidisciplinary team working on diabetic foot (DF) patients with critical limb ischemia (CLI) in a specialized center, the authors retrospectively traced all the patients admitted in their department in 3 consecutive years with a diagnosis of CLI. From January 2006 to December 2008, 245 consecutive DF patients with CLI according the TransAtlantic interSociety Consensus II criteria were included in the study. Treatment strategy was decided by a team of diabetologists, inteventional radiologists, and vascular surgeons. Technical and clinical success, mortality, and ulcer recurrence were evaluated at 6 months and at a mean follow-up of 19.5 ± 13.4 months. Percutaneous transluminal angioplasty (PTA) was performed in 189 (77%) patients, whereas medical treatment, open surgical revascularization (OSR), and primary amputation were performed in 44 (18.3%), 11 (4.3%), and 1 (0.5%) patients, respectively. Revascularization was successful in 227/233 (97.4%) patients. At follow-up, the overall clinical success rate was 60.4%; it was significantly ( P = .001) higher after revascularization (75.9%) compared with medical treatment (48.3%). During follow-up, surgical interventions in the foot were 1.5 ± 0.4 in those treated with PTA, 1.6 ± 0.5 in those treated with OSR, and 0.3 ± 0.8 in those receiving medical therapy ( P < .05 compared with the others). Ulcer recurrence occurred in 29 (11.8%) patients: 4 (1.6%) in PTA, 2 (0.8%) in OSR, and 23 (9.4%) in the medical therapy group ( P < .05). Major amputation rate was 9.3%, being significantly ( P = .04) lower after revascularization (5.2%) compared with medical therapy alone (13.8%). Cumulative mortality rate was 10.6%. In conclusion, this study confirms the positive role of a PTA-first approach for revascularizing the complex cases of DF with CLI in a teamwork management strategy.

Từ khóa


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Thông tin xuất bản

International Journal of Lower Extremity Wounds

Tập 11 Số 2

113-119

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