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Factors related to outcome of neuroischemic/ischemic foot ulcer in diabetic patients.

Apelqvist, Jan LU ; Elgzyri, Targ LU ; Larsson, Jan; Löndahl, Magnus LU ; Nyberg, Per LU and Thörne, Johan LU (2011) In Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 53. p.1582-1588
Abstract
OBJECTIVES: Peripheral vascular disease (PVD) is an important limiting factor for healing in neuroischemic or ischemic diabetic foot ulcer. The purpose of this study was to identify factors related to healing in patients with diabetes with foot ulcers and severe PVD. METHODS: Patients with diabetes with a foot ulcer, consecutively presenting at a multidisciplinary foot center with a systolic toe pressure <45 mm Hg or an ankle pressure <80 mm Hg were prospectively included, followed according to a preset program, and with the exception of specified exclusions, subjected to angiography offered vascular intervention when applicable. All patients had continuous follow-up until healing or death irrespective of the type of vascular... (More)
OBJECTIVES: Peripheral vascular disease (PVD) is an important limiting factor for healing in neuroischemic or ischemic diabetic foot ulcer. The purpose of this study was to identify factors related to healing in patients with diabetes with foot ulcers and severe PVD. METHODS: Patients with diabetes with a foot ulcer, consecutively presenting at a multidisciplinary foot center with a systolic toe pressure <45 mm Hg or an ankle pressure <80 mm Hg were prospectively included, followed according to a preset program, and with the exception of specified exclusions, subjected to angiography offered vascular intervention when applicable. All patients had continuous follow-up until healing or death irrespective of the type of vascular intervention. RESULTS: One thousand one hundred fifty-one patients were included. Eighty-two percent had a toe pressure <45 mm Hg and 49% had an ankle pressure <80 mm Hg. Eight hundred one patients (70%) underwent an angiography. Out of these, 63% had vascular intervention, either percutaneous transluminal angioplasty (PTA; 39%) or reconstructive surgery (24%). Nine percent of the patients had one or more complications after angiography. PTA was multisegmental in 46% and to the crural arteries in 46%. Reconstructive surgery was distal in 51%. Age (P < .001), renal function impairment (P = .005), congestive heart failure (P = .01), number and type of ulcer (P < .001), and severity of PVD (P = .003) affected the outcome of ulcers. PTA and reconstructive vascular surgery increased the probability of healing without amputation (odds ratio [OR], 1.77 and 2.05, respectively). CONCLUSION: Probability of ulcer healing is strongly related to comorbidity, extent of tissue involvement, and severity of PVD in patients with diabetes with severe PVD. (Less)
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author
organization
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Contribution to journal
publication status
published
subject
in
Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
volume
53
pages
1582 - 1588
publisher
Mosby
external identifiers
  • WOS:000291410600019
  • PMID:21515021
  • Scopus:79957447364
ISSN
1097-6809
DOI
10.1016/j.jvs.2011.02.006
language
English
LU publication?
yes
id
019ff0d1-e6ad-4271-8e2c-b9456443e9ee (old id 1936812)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/21515021?dopt=Abstract
date added to LUP
2011-05-02 16:06:30
date last changed
2016-10-30 04:34:50
@misc{019ff0d1-e6ad-4271-8e2c-b9456443e9ee,
  abstract     = {OBJECTIVES: Peripheral vascular disease (PVD) is an important limiting factor for healing in neuroischemic or ischemic diabetic foot ulcer. The purpose of this study was to identify factors related to healing in patients with diabetes with foot ulcers and severe PVD. METHODS: Patients with diabetes with a foot ulcer, consecutively presenting at a multidisciplinary foot center with a systolic toe pressure &lt;45 mm Hg or an ankle pressure &lt;80 mm Hg were prospectively included, followed according to a preset program, and with the exception of specified exclusions, subjected to angiography offered vascular intervention when applicable. All patients had continuous follow-up until healing or death irrespective of the type of vascular intervention. RESULTS: One thousand one hundred fifty-one patients were included. Eighty-two percent had a toe pressure &lt;45 mm Hg and 49% had an ankle pressure &lt;80 mm Hg. Eight hundred one patients (70%) underwent an angiography. Out of these, 63% had vascular intervention, either percutaneous transluminal angioplasty (PTA; 39%) or reconstructive surgery (24%). Nine percent of the patients had one or more complications after angiography. PTA was multisegmental in 46% and to the crural arteries in 46%. Reconstructive surgery was distal in 51%. Age (P &lt; .001), renal function impairment (P = .005), congestive heart failure (P = .01), number and type of ulcer (P &lt; .001), and severity of PVD (P = .003) affected the outcome of ulcers. PTA and reconstructive vascular surgery increased the probability of healing without amputation (odds ratio [OR], 1.77 and 2.05, respectively). CONCLUSION: Probability of ulcer healing is strongly related to comorbidity, extent of tissue involvement, and severity of PVD in patients with diabetes with severe PVD.},
  author       = {Apelqvist, Jan and Elgzyri, Targ and Larsson, Jan and Löndahl, Magnus and Nyberg, Per and Thörne, Johan},
  issn         = {1097-6809},
  language     = {eng},
  pages        = {1582--1588},
  publisher    = {ARRAY(0x5407c70)},
  series       = {Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter},
  title        = {Factors related to outcome of neuroischemic/ischemic foot ulcer in diabetic patients.},
  url          = {http://dx.doi.org/10.1016/j.jvs.2011.02.006},
  volume       = {53},
  year         = {2011},
}