Lower limb arterial intervention or autologous platelet-rich gel treatment of diabetic lower extremity arterial disease patients with foot ulcers

Abstract

Background: To investigate whether lower limb vascular intervention or autologous platelet-rich gel (APG) treatment would benefit diabetic lower extremity arterial disease (LEAD) patients with foot ulcers.Methods: A total of 82 diabetic LEAD patients with foot ulcers were recruited and divided into three groups: group A (30 patients received basal treatment), group B (21 patients received basal and APG treatment), and group C (31 patients received basal and lower limb vascular intervention treatment). All patients underwent routine follow-up visits for 6 months. The baseline characteristics and parameters were examined. After treatment, changes in all parameters from baseline were recorded. The differences between groups and the relationship among each parameter were determined.Results: There were no differences in the ankle brachial index (ABI) or major amputation between groups A and B (P>0.05). Compared with groups A and B, the ABI and major amputation rate of group C were improved (P<0.05). There were no significant differences in transcutaneous oxygen partial pressure (TcPO 2 ), the heal rate or minor amputation between groups A and C (P>0.05). Compared with groups A and C, TcPO 2 , the heal rate and minor amputation of group B were improved (P<0.05). The logistic regression analysis indicated that major amputation was mainly associated with the ABI, and minor amputation was mainly associated with TcPO 2 . Lower limb vascular intervention improves the ABI and reduces major amputation, and APG improves TcPO 2 and reduces minor amputation. Conclusions:In diabetic LEAD patients with foot ulcers, major amputation was mainly associated with the ABI, while minor amputation was mainly associated with TcPO 2 . Interventional surgery (angioplasty) mainly improves the ABI, reduces the incidence of major amputation and improves the macrovasculature, and APG mainly improves local TcPO 2 , reduces the incidence of minor amputation and improves the microcirculation.

Predictive risk factors for lower limb amputations in patients with diabetic foot ulcer in correlation with Wagner’s grading

“…The degree of renal impairment correlates strongly with the incidence and prevalence of DFU. 10,11,19,21,33 In our study , 3 (6%) had a serum creatinine level less than 0.9 at day 1 and 6 (12%) had levels less than 0.9 at month 3. The number of patients who had serum creatinine levels between 0.9-1.3 was 24 (46%) and 26 (52%) at day 1 and month 3 respectively.…”