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Factors PredicingUlcer Healing after Angioplasty in Diabetc Foot

Karatparambil Abid Ali* , Karatparambil Abid Ali* , Tom Thomas Kattoor* , Sunil Rajendran*

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New Indian Journal of Surgery 8(1):p 39-45, January - March 2017. | DOI: https://dx.doi.org/10.21088/nijs.0976.4747.8117.7

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Abstract

 Background:Non healing ulcers are a very common complication of diabetes. It increases the morbidity and economic burden of the patient. Ischemia is one of the common causes for none healing in diabetic patient. Even after angioplastic revascularization some patients’ shows delay in healing. Non achievement of direct flow to ulcer area may be a reason for this and it was proposed by Ian Taylor who in his angiosome concept. Objective: To evaluate the factors predicting outcome after revascularization based on angiosome concept in Diabetic Foot Ulcer. Methods : A prospective observational study was done which included 50 diabetic foot ulcer patient who underwent endovascular revascularization in our hospital during the period January 2013 to March 2015 and they were followed up for 6 months to look for Ulcer healing rate, ulcer recurrence, leg salvage rate and major amputation . Results: Out of 50 participants in 52% direct revascularization was done. Base line characteristics of both the groups were comparable except gender (where proportion of females was higher in indirect group), CKD, smoking, UTCWS grade of ulcer which were more in direct group. Ulcer predominantly affected toes (70%) and Anterior Tibial angiosome was the most common (50%) angiosome involved by clinical classification. Most common affected arterial segment pattern by Peripheral angiogram was multisegmental followed by infrapopliteal disease. In 78.3% of cases ulcer healed at 6 months in the indirect group whereas 57.7% patients had healed ulcers at 6 months in the Direct group (p value =0.12). Female gender, CKD, smoking and ulcer grade found to have no association with healing at 6 months. No significant difference was found in leg salvage rate, ulcer recurrence and major amputation. Conclusion: Endovascular revascularization is a good modality to reduce morbidity in diabetic foot ulcer patients. There was no significant difference in outcome between these two groups.

 

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DOI: https://dx.doi.org/10.21088/nijs.0976.4747.8117.7

Keywords

Peripheral Occlusive Arterial Disease; Diabetic Foot Ulcer; Angiosome; Peripheral Percutaneous Trans Luminal Angioplasty; Peripheral Angiogram.

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