Korean J Radiol.  2018 Feb;19(1):47-53. 10.3348/kjr.2018.19.1.47.

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

• Troisi N
• Turini F
• Chisci E
• Ercolini L
• Frosini P
• Lombardi R
• Falciani F
• Baggiore C
• Anichini R
• Michelagnoli S

• KMID: 2425108
• DOI: http://doi.org/10.3348/kjr.2018.19.1.47

Abstract

OBJECTIVE
To 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 METHODS
Between 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.
RESULTS
Postprocedural 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).
CONCLUSION
Pedal arch status has a positive impact on time to healing, limb salvage, and survival in diabetic patients with foot wounds undergoing infrainguinal endovascular revascularization.

Keyword

Diabetic foot; Tibial artery; Revascularization; Pedal arch; Plantar arch

MeSH Terms

Amputation
Angiography
Diabetic Foot
Foot*
Freedom
Humans
Limb Salvage
Retrospective Studies
Tibial Arteries
Wounds and Injuries*

Figure

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  Fig. 1 Pedal arch status on postprocedural angiography: CPA (A), IPA (B), APA (C).APA = absent pedal arch, Arch = pedal arch, CPA = complete pedal arch, IPA = incomplete pedal arch, PedA = pedis artery, PlaA = plantar artery

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  Fig. 2 Estimated 1-year Kaplan-Meier freedom from minor amputation.

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  Fig. 3 Estimated 1-year Kaplan-Meier limb salvage.

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  Fig. 4 Estimated 1-year Kaplan-Meier survival.

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