Impact of Pedal Arch Patency on Tissue Loss and Time to Healing in Diabetic Patients with Foot Wounds Undergoing Infrainguinal Endovascular Revascularization

Abstract

ObjectiveTo retrospectively evaluate the impact of pedal arch quality on tissue loss and time to healing in diabetic patients with foot wounds undergoing infrainguinal endovascular revascularization.Materials and MethodsBetween January 2014 and June 2015, 137 consecutive diabetic patients with foot wounds underwent infrainguinal endovascular revascularization (femoro-popliteal or below-the-knee, arteries). Postprocedural angiography of the foot was used to divide the patients into the following three groups according to the pedal arch status: complete pedal arch (CPA), incomplete pedal arch (IPA), and absent pedal arch (APA). Time to healing and estimated 1-year outcomes in terms of freedom from minor amputation, limb salvage, and survival were evaluated and compared among the three groups.ResultsPostprocedural angiography showed the presence of a CPA in 42 patients (30.7%), IPA in 60 patients (43.8%), and APA in 35 patients (25.5%). Healing within 3 months from the procedure was achieved in 21 patients with CPA (50%), 17 patients with IPA (28.3%), and in 7 patients with APA (20%) (p = 0.01). There was a significant difference in terms of 1-year freedom from minor amputation among the three groups (CPA 84.1% vs. IPA 82.4% vs. APA 48.9%, p = 0.001). Estimated 1-year limb salvage was significantly better in patients with CPA (CPA 100% vs. IPA 93.8% vs. APA 70.1%, p < 0.001). Estimated 1-year survival was significantly better in patients with CPA (CPA 90% vs. IPA 80.8% vs. APA 62.7%, p = 0.004).ConclusionPedal arch status has a positive impact on time to healing, limb salvage, and survival in diabetic patients with foot wounds undergoing infrainguinal endovascular revascularization.

2D perfusion DSA with an open-source, semi-automated, color-coded software for the quantification of foot perfusion following infrapopliteal angioplasty: a feasibility study

“…Finally, in patient #5, no arch was visible after revascularization and an increase in perfusion was noted only in restricted tissue areas around the revascularized anterior tibial artery. This patient underwent major above the knee amputation 1 month after the procedure, further highlighting the fact that the achievement of vessel patency is not synonymous to clinical success, as well as the impact of pedal arch outflow for limb salvage, as previously reported [17].…”

New Innovations and Devices in the Management of Chronic Limb-Threatening Ischemia

“…49,50 Patency following revascularization is improved with patent pedal vessels and plantar arch and is associated with faster wound healing. 51–55 In the RENDEZVOUS registry, 56 patients who received pedal artery angioplasty had significantly higher rates of wound healing and a shorter time to wound healing compared to those who did not. However, long-term patency of pedal angioplasty has not been assessed but is likely limited.…”

Digital Subtraction Angiography Prior to an Amputation for Critical Limb Ischemia (CLI): An Expert Recommendation Statement From the CLI Global Society to Optimize Limb Salvage

“…28,29,31 Proper imaging of the pedal arteries is also important since pedal arch flow is a positive prognostic marker for limb salvage and survival in patients with CLI. 34…”