Atherosclerotic Obstruction of Lower Limb Arteries in Diabetic Foot: Effectiveness of Percutaneous Intervention

ABSTRACT

BACKGROUND AND OBJECTIVES: Peripheral arterial disease is a risk factor for foot ulcers and amputation in diabetic patients. Percutaneous intervention of an obstructed lower limb artery is one of the treatments for diabetic foot;however, few data are available on this treatment and its effectiveness. The aim of this study was to investigate atherosclerotic obstruction in lower limb arteries and to evaluate the feasibility and effectiveness of percutaneous intervention in salvaging a lower limb with diabetic foot. SUBJECTS AND METHODS: Fifty-two consecutive subjects (mean age64) with diabetic foot underwent angiography of the lower limbs. In patients with significant narrowing (diameter stenosis >50%), percutaneous intervention was performed. Angiographic success was defined as restoration of distal blood flow with residual stenosis less than 30%. During follow-up, bypass surgery was performed when clinically indicated in some patients and the state of diabetic foot was evaluated. RESULTS: Forty-nine patients (94%) showed atherosclerotic narrowings in lower limb arteries and 34 of them (65%) had significant lesions. Among those 34 subjects, interventions were carried out in 30 cases (balloon angioplasty in 11, stenting in 18, and intra-arterial thrombolytic therapy in 1). In the other 15, intervention was not indicated. Twenty-six (86%) of the 30 procedures were angiographically successful. During the follow-up (7+/-6 months), 12 subjects (57%) experienced wound healing with or without forefoot amputation or bypass surgery, whereas 3 had major amputation. Four patients died during the period. CONCLUSION: The majority of patients with diabetic foot had atherosclerotic obstruction in lower limb arteries. Percutaneous intervention may salvage limbs and reduce the rate of major amputation in patients with diabetic foot.