In a recently published study, researchers found that successful revascularization led to healed ischemic diabetic foot ulcers (DFUs) at one year in greater than 56 percent of patients with an average age of 70.5 and a mean duration of type 2 diabetes of more than 22 years.
The single-center retrospective study, published online by the Journal of Clinical Medicine, included 80 patients with ischemic DFUs and below-the-ankle arterial disease.1 Over 72 percent of the patients had an ulcer size greater than 5 cm2 and 81 percent had infected wounds. The study authors also noted that over 76 percent of the patient cohort had ischemic heart disease and over one-third had heart failure. Yet in this study population with significant comorbidities, Meloni and colleagues found that successful revascularization of the foot had a nearly 10-fold greater percentage of healed ischemic DFUs at one year and greater than 1/3 reduction of risk of minor and major amputations in comparison to those who had failed foot revascularization.
“I think this study really confirmed a lot of providers’ experiences in dealing with this very complicated patient population,” notes David G. Armstrong, DPM, MD, PhD, the President of the American Limb Preservation Society (ALPS) and a Professor of Surgery at the Keck School of Medicine at the University of Southern California. “The bottom line is that aggressive revascularization in this patient population may make a very big difference in prolonging limb and life. I think we are starting to see this sort of thing play out with more and more data in this direction. I think this may be true not only for surgical intervention or endovascular intervention but for optimal medical therapy and medical intervention as well. I really look forward to further works that are going to confirm or refute this.”
Adam Isaac, DPM, FACFAS cautions that the sample size was relatively small (80 patients) for a retrospective analysis and that all the revascularization procedures were performed at a single center. However, he says the study results are impressive in this patient population.
“When foot revascularization was performed, along with appropriate infection management, surgery and offloading, many limbs were successfully preserved,” notes Dr. Isaac, the Director of Research for Foot and Ankle Specialists of the Mid-Atlantic. “ … This is yet another example of how a multidisciplinary approach to the diabetic foot leads to improved outcomes and decreases major amputations.”
Dr. Isaac says having a strong network of interdisciplinary colleagues is essential to facilitating timely referrals in a high-risk patient population.
“Direct communication between podiatric and vascular colleagues is key to getting patients what they need in a timely manner,” adds Dr. Isaac. “In my experience, even during the course of a busy day, there is no substitute for a phone call. If you, as the provider, are showing that much investment in a patient’s well-being, it is awfully hard for the person on the other line to ignore the urgency of the matter.”
1. Meloni M, Morosetti D, Giurato L, et al. Foot revascularization avoids major amputation in persons with diabetes and ischaemic foot ulcers. J Clin Med. 2021;10(17):3977. doi: 10.3390/jcm10173977