Outcomes of Three Years of Teamwork on Critical Limb Ischemia in Patients With Diabetes and Foot Lesions

Abstract

To evaluate the outcomes of a multidisciplinary team working on diabetic foot (DF) patients with critical limb ischemia (CLI) in a specialized center, the authors retrospectively traced all the patients admitted in their department in 3 consecutive years with a diagnosis of CLI. From January 2006 to December 2008, 245 consecutive DF patients with CLI according the TransAtlantic interSociety Consensus II criteria were included in the study. Treatment strategy was decided by a team of diabetologists, inteventional radiologists, and vascular surgeons. Technical and clinical success, mortality, and ulcer recurrence were evaluated at 6 months and at a mean follow-up of 19.5 ± 13.4 months. Percutaneous transluminal angioplasty (PTA) was performed in 189 (77%) patients, whereas medical treatment, open surgical revascularization (OSR), and primary amputation were performed in 44 (18.3%), 11 (4.3%), and 1 (0.5%) patients, respectively. Revascularization was successful in 227/233 (97.4%) patients. At follow-up, the overall clinical success rate was 60.4%; it was significantly (P = .001) higher after revascularization (75.9%) compared with medical treatment (48.3%). During follow-up, surgical interventions in the foot were 1.5 ± 0.4 in those treated with PTA, 1.6 ± 0.5 in those treated with OSR, and 0.3 ± 0.8 in those receiving medical therapy (P < .05 compared with the others). Ulcer recurrence occurred in 29 (11.8%) patients: 4 (1.6%) in PTA, 2 (0.8%) in OSR, and 23 (9.4%) in the medical therapy group (P < .05). Major amputation rate was 9.3%, being significantly (P = .04) lower after revascularization (5.2%) compared with medical therapy alone (13.8%). Cumulative mortality rate was 10.6%. In conclusion, this study confirms the positive role of a PTA-first approach for revascularizing the complex cases of DF with CLI in a teamwork management strategy.

Global recurrence rates in diabetic foot ulcers: A systematic review and meta‐analysis

“…One hundred eighty‐two full‐text articles were assessed for eligibility, and 133 (65 reviews, eight studies of duplicated population, and 60 studies with data that cannot be extracted) of them were removed since they did not meet our selection criteria. Finally, 49 articles were included in our meta‐analysis after full‐text review …”

Application of the Five Stages of Grief to Diabetic Limb Loss and Amputation

“…A multidisciplinary team approach to the diabetic foot has been widely recognized to lead to increased rates of wound healing, decreased major limb amputation levels, lower healthcare costs, and improved patient care (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). However, a potentially underappreciated component of this team is that of psychiatry.…”

Longitudinal Analysis of Quality of Diabetes Care and Relational Climate in Primary Care

“…The treatment strategy was decided jointly by a team including diabetologists, radiologists, and vascular surgeons (Scatena et al. ). Similarly, Peterson and colleagues concluded that strengthening collaboration among providers reduced mean glycated hemoglobin (HbA1c) across 12 pediatric diabetes centers in Sweden.…”