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Amputation-free survival in patients with diabetic foot ulcer and peripheral arterial disease : Endovascular versus open surgery in a propensity score adjusted analysis

Butt, Talha LU ; Lilja, Erika LU orcid ; Elgzyri, Targ LU ; Apelqvist, Jan LU ; Gottsäter, Anders LU ; Engström, Gunnar LU and Acosta, Stefan LU orcid (2020) In Journal of Diabetes and its Complications 34(5).
Abstract

Aims: The aim of the present study was to compare outcomes of endovascular surgery versus open vascular surgery in patients with diabetic foot ulcer (DFU) and peripheral arterial disease (PAD). Methods: Between 1984 and 2006, 1151 patients with DFU were admitted to the diabetic foot care team. Three hundred seventy-six patients with 408 limbs were consecutively included at a multidisciplinary foot center, 289 limbs were treated with endovascular surgery and 119 limbs with open vascular surgery first strategy. A propensity score adjusted analysis was performed to compare outcomes for type of revascularization. Results: Major amputation rates at 3 years were 17.0% and 16.8% (p = 0.97) and mortality at 3 years were 43.1% and 46.5% (p =... (More)

Aims: The aim of the present study was to compare outcomes of endovascular surgery versus open vascular surgery in patients with diabetic foot ulcer (DFU) and peripheral arterial disease (PAD). Methods: Between 1984 and 2006, 1151 patients with DFU were admitted to the diabetic foot care team. Three hundred seventy-six patients with 408 limbs were consecutively included at a multidisciplinary foot center, 289 limbs were treated with endovascular surgery and 119 limbs with open vascular surgery first strategy. A propensity score adjusted analysis was performed to compare outcomes for type of revascularization. Results: Major amputation rates at 3 years were 17.0% and 16.8% (p = 0.97) and mortality at 3 years were 43.1% and 46.5% (p = 0.55) after endovascular surgery and open vascular surgery, respectively. In the propensity score adjusted analysis, patients undergoing endovascular surgery first had similar outcomes in terms of major amputation, mortality, combined major amputation/mortality compared to those undergoing open vascular surgery. Longer time to intervention (p = 0.003) was associated with increased major amputation rate in the multivariable Cox regression analysis. Conclusion: The endovascular surgery first and open vascular surgery first strategies were associated with similar long-term results in a large cohort of patients with DFU and PAD undergoing revascularization. Rapid revascularization reduces the risk of amputation.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Diabetic foot ulcer, Endovascular surgery, Open vascular surgery, Peripheral arterial disease, Propensity score adjusted analysis
in
Journal of Diabetes and its Complications
volume
34
issue
5
article number
107551
publisher
Elsevier
external identifiers
  • scopus:85079375018
  • pmid:32061519
ISSN
1056-8727
DOI
10.1016/j.jdiacomp.2020.107551
language
English
LU publication?
yes
id
d80ac79d-4460-4286-aa20-7ae2500efb55
date added to LUP
2020-03-03 14:06:53
date last changed
2024-06-12 09:53:06
@article{d80ac79d-4460-4286-aa20-7ae2500efb55,
  abstract     = {{<p>Aims: The aim of the present study was to compare outcomes of endovascular surgery versus open vascular surgery in patients with diabetic foot ulcer (DFU) and peripheral arterial disease (PAD). Methods: Between 1984 and 2006, 1151 patients with DFU were admitted to the diabetic foot care team. Three hundred seventy-six patients with 408 limbs were consecutively included at a multidisciplinary foot center, 289 limbs were treated with endovascular surgery and 119 limbs with open vascular surgery first strategy. A propensity score adjusted analysis was performed to compare outcomes for type of revascularization. Results: Major amputation rates at 3 years were 17.0% and 16.8% (p = 0.97) and mortality at 3 years were 43.1% and 46.5% (p = 0.55) after endovascular surgery and open vascular surgery, respectively. In the propensity score adjusted analysis, patients undergoing endovascular surgery first had similar outcomes in terms of major amputation, mortality, combined major amputation/mortality compared to those undergoing open vascular surgery. Longer time to intervention (p = 0.003) was associated with increased major amputation rate in the multivariable Cox regression analysis. Conclusion: The endovascular surgery first and open vascular surgery first strategies were associated with similar long-term results in a large cohort of patients with DFU and PAD undergoing revascularization. Rapid revascularization reduces the risk of amputation.</p>}},
  author       = {{Butt, Talha and Lilja, Erika and Elgzyri, Targ and Apelqvist, Jan and Gottsäter, Anders and Engström, Gunnar and Acosta, Stefan}},
  issn         = {{1056-8727}},
  keywords     = {{Diabetic foot ulcer; Endovascular surgery; Open vascular surgery; Peripheral arterial disease; Propensity score adjusted analysis}},
  language     = {{eng}},
  number       = {{5}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Diabetes and its Complications}},
  title        = {{Amputation-free survival in patients with diabetic foot ulcer and peripheral arterial disease : Endovascular versus open surgery in a propensity score adjusted analysis}},
  url          = {{http://dx.doi.org/10.1016/j.jdiacomp.2020.107551}},
  doi          = {{10.1016/j.jdiacomp.2020.107551}},
  volume       = {{34}},
  year         = {{2020}},
}