Influence Of Clinical Presentation Of Diabetic Patients With Chronic Limb Threatening Ischemia Submitted To Distal Revascularization

Authors

  • Catarina Rolo Santos Department of General Surgery, Unidade Local de Saúde Arco Ribeirinho, EPE https://orcid.org/0000-0002-3899-670X
  • Diogo Cunha e Sá Department of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Portugal
  • Tony R. Soares Department of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Portugal
  • José Gimenez Department of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Portugal
  • Tiago Costa Department of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Portugal
  • Gonçalo Cabral Department of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Portugal
  • José Tiago Department of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Portugal
  • Armanda Duarte Department of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Portugal

DOI:

https://doi.org/10.48729/pjctvs.477

Keywords:

diabetes, CLTI, distal revascularization, infrapopliteal, infragenicular, bypass, diabetic foot ulcer

Abstract

Objective: The purpose of this article was to evaluate the clinical impact of diabetic foot ulcer (DFU) severity in patients with chronic limb-threatening ischemia (CLTI) who underwent distal open revascularization.

Methods: This study included a single-center retrospective analysis of diabetic patients with CLTI who underwent distal revascularization between January 2012 and December 2019. The sample was divided into two groups according to DFU severity; group 1 was defined if observed Wound grade ≥ 2 and Infection grade ≥ 1 and group 2 was defined if observed Wound grade < 2 and Infection grade < 1, according to Wound, Ischemia, and foot Infection (WIfI) classification. The primary endpoint was achieving freedom from CLTI at 1 year. Secondary endpoints encompassed the recurrence of CLTI, limb salvage, amputation-free survival, overall survival, and primary patency over a 4-year follow-up period.

Results: A total of 258 distal bypasses were performed in diabetic patients with CLTI. Among these, 95 patients had infected major foot lesions (group 1), while the remaining 163 limbs comprised group 2. Group 1 patients were slightly younger, with a median age of 72 years (IQR 14), compared to 74 years (IQR 14) in group 2 (p=0.045). Most of the patients achieved freedom from CLTI at 12 months (82%), with no significant differences between groups (HR 0.75, CI 0.53-1.04, p=0.084; aHR 0.77, CI 0.54-1.08, p=0.130). At 4 years of follow-up, recurrence rates of CLTI and limb salvage were no different between groups (HR 0.68, CI 0.34-1.35, p=0.266; aHR 0.71, CI 0.34-1.48, p=0.355 and HR 1.18, CI 0.63-2.24, p=0.591; aHR 1.81, CI 0.80-4.11, p=0.155, respectively). Survival-related end points were not different between groups, except when adjusted for baseline characteristics and graft type (survival: HR 1.50, CI 0.96-2.33, p=0.072; aHR 2.49, CI 1.54-4.05, p<0.001; amputation-free survival: HR 1.37, CI 0.97-1.92, p=0.071; aHR 2.03, CI 1.40-2.93, p<0.001).

Conclusion: The present study emphasizes the value of distal revascularization in limb salvage of patients with diabetic foot, independently of the DFU severity. However, these results suggest a lower survival in patients with infected major foot lesions. Further studies are needed to assert these findings.

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References

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Published

04-08-2025

How to Cite

1.
Rolo Santos C, Cunha e Sá D, R. Soares T, Gimenez J, Costa T, Cabral G, Tiago J, Duarte A. Influence Of Clinical Presentation Of Diabetic Patients With Chronic Limb Threatening Ischemia Submitted To Distal Revascularization. Rev Port Cir Cardiotorac Vasc [Internet]. 2025 Aug. 4 [cited 2025 Sep. 5];32(2):25-30. Available from: https://pjctvs.com/index.php/journal/article/view/477

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