A study first published online on 12 September in the Journal of Interventional Cardiology suggests that endovascular treatment of diabetic foot syndrome using mixed coronary and peripheral materials and techniques leads to high immediate success and limb salvage rates compared to historical series.
Authors of the study, Paolo Cardaioli, department of Interventional Cardiology, University of Padova Medical School, Padova, Italy et al set out to assess the long-term results of interventional treatment of diabetic foot using mixed coronary and peripheral equipments and techniques.
A diabetic foot exhibits any pathology that results directly from diabetes mellitus or any chronic complication of diabetes mellitus. Presence of several characteristic diabetic foot pathologies is called diabetic foot syndrome. Interventional treatment for the diabetic foot is rapidly becoming the therapy of choice for patients, but proper materials and techniques are still debated, wrote the authors.
The investigators prospectively enrolled 220 diabetic patients (78.5±15.8 years, 107 female, all with Fontaine III or IV class) from January 2006 to December 2010 who were referred to our center for diabetic foot syndrome and severe limb ischaemia. They used techniques using both coronary and peripheral guidewires and balloons. Doppler ultrasonography and foot transcutaneous oxygen pressure (TcPO2) before and after the procedure were calculated as well as the amputation rate.
Cardaioli et al point out that the preferred approach was ipsilateral femoral antegrade in 170/220 patients (77.7%), contralateral cross-over in 40/220 patients (18.8%), and popliteal retrograde plus femoral antegrade in 10/220 patients (4.5%).
They explain that the techniques included combined use of coronary and dedicated peripheral guidewires and coronary and peripheral dedicated balloons. “Percutaneous balloon angioplasty was performed in 252 legs, and contributing to these were 32 patients with bilateral disease. The procedure was successful in 239/252 legs with an immediate success rate of 94.8% and a significant improvement in TcPO2 and ankle-brachial index with ulcer healing in 233/252 legs (92.4%).” Authors wrote that the freedom from major amputation was 82.8% at a mean follow-up of 3.1±1.8 years (range one to five years).