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Small Artery Disease as a Predictor of Wound Healing in Patients with Diabetic Foot After Revascularization

Radka Jarosiková1,2, Theodor Adla3, Patrik Turza3

  • 1Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.

The International Journal of Lower Extremity Wounds
|March 13, 2025
PubMed

Insights

Advanced arterial calcification negatively impacts diabetic foot ulcer healing and amputation risk six months post-procedure. This finding is crucial for managing peripheral arterial disease complications.

Area of Science:

  • Vascular Medicine
  • Radiology
  • Diabetology

Background:

  • Diabetic foot ulcers (DFUs) are a major cause of lower limb amputations.
  • Peripheral arterial disease (PAD) severity and endovascular treatment outcomes are critical in DFU management.
  • Medial arterial calcification (MAC) and small artery disease (SAD) are common in PAD patients but their long-term impact on DFU outcomes post-intervention requires further clarification.

Purpose of the Study:

  • To investigate the hypothesis that advanced medial arterial calcification (MAC)/small artery disease (SAD) adversely impacts outcomes in DFU patients after successful endovascular procedures.
  • To assess the association between MAC/SAD scores and primary DFU outcomes (healing, amputations) and secondary outcomes (mortality, TcPO2).

Main Methods:

  • Retrospective study of 54 patients with DFUs who underwent percutaneous transluminal angioplasty (PTA).
  • MAC/SAD was quantified using a three-level scoring system based on radiographs.
  • Patients were grouped by MAC/SAD score and compared for DFU outcomes at three and six months post-PTA.

Main Results:

  • MAC/SAD scores increased significantly with age (p=0.014).
  • No significant association between MAC/SAD score and amputation risk or DFU healing at three months post-PTA.
  • Significant association observed between MAC/SAD score and long-term DFU outcomes (unhealed ulcers, amputations) at six months (p=0.043).
  • MAC/SAD score correlated with PAD severity (Global Limb Anatomic Staging System, p=0.042; Graziani system, p=0.019) and negatively with TcPO2 levels post-PTA.

Conclusions:

  • Advanced MAC/SAD is significantly associated with poorer long-term outcomes in DFU patients, including increased risk of lower limb amputations.
  • The impact of MAC/SAD on DFU outcomes becomes apparent beyond the initial three months post-revascularization.
  • MAC/SAD scoring may aid in risk stratification for DFU patients undergoing endovascular treatment.
Keywords:
diabetic footperipheral arterial diseasesmall artery diseasewound healing

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