A systematic review of the effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral arterial disease

Diabetes/Metabolism Research and Reviews - Tập 28 Số S1 - Trang 179-217 - 2012
Robert J. Hinchliffe1,2, George Andros3, Jan Apelqvist4, K. Bakker5, S. Fiedrichs6, Johannes Lämmer7, Mauri Lepäntalo8, Joseph L. Mills9, Jim A. Reekers10, Clifford P. Shearman11, Gerlof D. Valk12, R. Eugene Zierler13, Nicolaas C. Schaper6
1R. J. Hinchliffe, St George's Vascular Institute, 4th Floor, St James Wing, St George's Healthcare NHS Trust, Blackshaw Road, London SW17 0QT, UK.
2St. George's Vascular Institute, St. George's Healthcare NHS Trust, London, UK
3Amputation Prevention Center, Valley Presbyterian Hospital, Los Angeles, CA, USA
4Department of Endocrinology, University Hospital of Malmö, Malmö, Sweden
5IWGDF, Heemstede, The Netherlands
6Division of Endocrinology, MUMC+, CARIM Institute, Maastricht, The Netherlands
7Department of Radiology, Medical University Vienna, Vienna, Austria
8Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland
9Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona Health Sciences Center, Tuscon, AZ, USA
10Department of Vascular Radiology, Amsterdam Medical Centre, Amsterdam, The Netherlands
11Department of Vascular Surgery, Southampton University Hospitals NHS Trust, Hampshire, UK
12Department of Internal Medicine, University Medical Center Utrecht, The Netherlands
13Department of Surgery, University of Washington, Seattle, WA USA

Tóm tắt

SummaryIn several large recent observational studies, peripheral arterial disease (PAD) was present in up to 50% of the patients with a diabetic foot ulcer and was an independent risk factor for amputation. The International Working Group on the Diabetic Foot therefore established a multidisciplinary working group to evaluate the effectiveness of revascularization of the ulcerated foot in patients with diabetes and PAD. A systematic search was performed for therapies to revascularize the ulcerated foot in patients with diabetes and PAD from 1980–June 2010. Only clinically relevant outcomes were assessed. The research conformed to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, and the Scottish Intercollegiate Guidelines Network methodological scores were assigned. A total of 49 papers were eligible for full text review. There were no randomized controlled trials, but there were three 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% (70.5–85.5%). At 1‐year follow‐up, 60% or more of ulcers had healed following revascularization with either open bypass surgery or endovascular revascularization. Studies appeared to demonstrate improved rates of limb salvage associated with revascularization compared with the results of medically 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. Copyright © 2012 John Wiley & Sons, Ltd.

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Diabetes/Metabolism Research and Reviews

Tập 28 Số S1

179-217

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