Outcome of diabetic foot ulcers after revascularisation in patients with peripheral arterial disease

To assess the outcome of endovascular revascularisation in patients with diabetes presenting with ischaemic foot ulcers.

This prospective observational study was conducted at the foot clinic of a tertiary care diabetes unit from August 2019 to September 2020. The Wound, Ischemia, and foot Infection (WIfI) classification method was used for wound classification. Foot ulcers were classified as ischaemic based on wound features, pedal pulses, ankle-brachial pressure index (ABPI) and arterial doppler ultrasound. Patients with diabetes with ischaemic foot ulcers were evaluated and treated according to the standard protocols. Patients undergoing endovascular revascularisation procedures were followed for 14 months post-procedure for the outcome measurement. The primary outcome of successful endovascular intervention was wound healing, either primarily or with a minor (below the malleoli) amputation.

A total of 95 patients were included (70% males) with a mean age of 61.78±11.03 years and a mean duration of diabetes of 16.99±10.4 years. Almost 85% of patients had foot infections with varying severity. Endovascular revascularisation procedure was successful in 90% of the study population and almost 75% of the patients achieved wound healing. The mean ABPI significantly improved from 0.82±0.78 to 1.00±0.46 (p=0.024). On angiography, it was observed that infrapopliteal vascular involvement, either alone or in combination with infrainguinal vessels, was observed in almost 70% of patients and the majority (85%) of them had a diffuse pattern of atherosclerosis.

The findings of this study demonstrated that successful endovascular revascularisation had a significant impact on wound healing and salvaging limbs in ischaemic diabetic foot ulcers.