Angiographic evaluation of peripheral arterial occlusive disease and its role as a prognostic determinant for major amputation in diabetic subjects with foot ulcers

• Published in: Diabetes care Vol. 21; no. 4; pp. 625 - 630
• Main Authors: Faglia, Ezio, Favales, Fabrizio, Quarantiello, Antonella, Calia, Patrizia, Clelia, Paratore, Brambilla, Giorgio, Rampoldi, Antonio, Morabito, Alberto
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.04.1998
• Subjects: Amputation; Amputation - statistics & numerical data; Analysis of Variance; Arterial Occlusive Diseases - diagnostic imaging; Biological and medical sciences; Blood pressure; Cardiovascular system; Contraindications; Creatinine; Debridement; Diabetes; Diabetic Angiopathies - diagnostic imaging; Diabetic Foot - surgery; Diabetic neuropathy; Electrolytes; Female; Femoral Artery; Foot Ulcer - surgery; Hospitals; Humans; Iliac Artery; Intermittent Claudication - diagnostic imaging; Intermittent Claudication - epidemiology; Investigative techniques, diagnostic techniques (general aspects); Leg ulcers; Male; Medical imaging; Medical sciences; Middle Aged; Multivariate Analysis; Patients; Predictive Value of Tests; Prognosis; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiography; Research design; Retrospective Studies; Tibial Arteries; Veins & arteries; Italy; Europe; Endocrinopathy; Performance evaluation; Skin disease; Prognosis; Angiography; Lower limb; Stenosis; Cardiovascular disease; Autoimmune disease; Non insulin dependent diabetes; Arterial disease; Vascular disease; Surgery; Adult; Complication; Ulcer; Human; Immunopathology; Radiodiagnosis; Stage classification; Artery; Foot; Surgical amputation; Insulin dependent diabetes; Elderly
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.21.4.625

Angiographic evaluation of peripheral arterial occlusive disease and its role as a prognostic determinant for major amputation in diabetic subjects with foot ulcers. E Faglia , F Favales , A Quarantiello , P Calia , P Clelia , G Brambilla , A Rampoldi and A Morabito Multimedica Institute, Sesto S. Giovanni, Milan, Italy. Abstract OBJECTIVE: To evaluate in diabetic patients with foot ulcers the angiographic findings of peripheral occlusive arterial disease and their role as a prognostic determinant for major amputation. RESEARCH DESIGN AND METHODS: From 1993 to 1995, 104 diabetic inpatients with foot ulcers underwent arteriography on the ulcerated limb. Stenoses in the iliac trunk, the superficial femoral artery, the profunda femoral artery, the popliteal artery, the anterior tibial artery, the posterior tibial artery, and the peroneal artery were scored on the basis of vessel lumen reduction: 0 if stenoses involved a reduction in the vessel lumen of < 50%, 1 if stenoses involved 50 to < 75% reduction, 2 if stenoses involved 75 to < 100% reduction, and 3 if total occlusion was present. The sum of the points assigned to each of these arteries was called the angiographic score. RESULTS: Stenoses causing a vessel lumen reduction > or = 50% were detected in 103 patients (99%). Stenoses were also detected in subjects with palpable foot pulses, ankle-brachial indexes > or = 1, or transcutaneous oxygen tension > or = 50 mmHg. The risk of major amputation was increased significantly when total occlusion was present in the popliteal and infrapopliteal arteries (chi 2 for trend = 50.57, P < 0.001). No major amputation was carried out in patients with angiographic scores < 10; major amputation was carried out in all the patients with scores > 14. Multivariate analysis indicated a high angiographic score as an independent risk factor for major amputation (odds ratio 2.32, P = 0.001, CI 1.40-3.84). CONCLUSIONS: Angiography permits an exact detection of occlusive arterial disease in subjects with normal results for noninvasive vascular procedures. A score that has a relevant prognostic value for major amputation can be obtained from the evaluation of the extent and diffusion of the stenoses.