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Frontiers in Biology

ISSN 1674-7984

ISSN 1674-7992(Online)

CN 11-5892/Q

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Frontiers in Biology  2018, Vol. 13 Issue (6): 458-463   https://doi.org/10.1007/s11515-018-1516-0
  本期目录
Effectiveness of revascularization of the ulcerated foot in diabetic patients with peripheral artery disease for one year follow-up
Mohammad Momen Gharibvand1, Mina Mounesi1(), Arman Shahriari2, Asghar Sharif Najafi2, Azim Motamed far1, Atefeh Roumi2
1. Department of Radiology, school of medicine,Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
2. Department of Internal Medicin, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Razi Hospital, Ahvaz, Iran
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Abstract：

BACKGROUND: Diabetes is an important risk factor for atherosclerosis. The diabetic foot is characterized by the presence of arteriopathy and neuropathy.When ischemia is diagnosed, restoration of pulsatile blood flow by revascularization may be considered for salvaging the limb. The treatment options are angioplasty with or without stenting and surgical bypass or hybrid procedures combining the two.

AIMS: To evaluate the outcomes of severe ischemic diabetic foot ulcers for which percutaneous transluminal angioplasty (PTA) was considered as the first-line vascular procedure. Factors associated with successful PTA were also evaluated.

METHODS: In 80 consecutive diabetic patients with foot ulcers and severe limb ischemia, PTA was performed if feasible. All patients were followed until healing or for one year. Clinical and angiographic factors in fluencing outcomes after PTA were sought by univariate and multivariate analysis.

RESULTS: PTA was done in 73 of the 80 (91.2%) patients, and considered clinically succe ssful in 58(79.9%). Successful PTA was significantly higher in patients with Superficial femoral artery, posterior Tibialis and dorsalis pedis arteries involvement in the univariate analysis. Seven patients were expired during the study follow up due to MI, pulmonary thromboembolism and GI bleeding.

CONCLUSION: PTA in diabetic patients with severe ischemic foot ulcers provided favorable. Some parameters could be used for predicting PTA successfulness.
Key words： percutaneous transluminal angioplasty    revascularization    diabetes
收稿日期: 2018-06-30      出版日期: 2018-11-30
Corresponding Author(s): Mina Mounesi   
 引用本文:   
. [J]. Frontiers in Biology, 2018, 13(6): 458-463.
Mohammad Momen Gharibvand, Mina Mounesi, Arman Shahriari, Asghar Sharif Najafi, Azim Motamed far, Atefeh Roumi. Effectiveness of revascularization of the ulcerated foot in diabetic patients with peripheral artery disease for one year follow-up. Front. Biol., 2018, 13(6): 458-463.
 链接本文:  
https://academic.hep.com.cn/fib/CN/10.1007/s11515-018-1516-0
https://academic.hep.com.cn/fib/CN/Y2018/V13/I6/458
Variables Frequency Percent
Age(mean±SD) 66.5±8.3 (48-82)
Gender Male 39 48.8%
Female 41 51.2%
Underlying Diseases HTN 54 67.5%
HLP 52 65%
CAD 55 68.8%
CVA 6 7.5%
Neuropathy 17 21.3%
Nephropathy 14 17.5%
Ulcer Size >5 38 47.5%
<5 42 52.5%
BMI >30 33 41.3%
<30 47 58.8%
Smoking 30 37.5%
Tab.1  
Arteries Variable Frequency Percent
Superficial femoral artery Mild (50-70) 17 21.3%
Moderate (70-90) 14 17.5%
Severe (>90) 7 8.8%
Near Ocluded (99) 0 0
Total 38 47.5%
Popliteal artery Mild (50-70) 9 11.3%
Moderate (70-90) 5 6.3%
Sever 0 0
Near Ocluded (99) 0 0
Total 14 17.5%
Anterior Tibialis artery Mild (50-70) 18 22.5%
Moderate (70-90) 16 20%
Severe (>90) 0 0
Near Ocluded (99) 7 8.8%
Total 41 51.2%
Posterior Tibialis artery Mild (50-70) 27 33.8%
Moderate (70-90) 13 16.3%
Severe (>90) 3 3.8%
Near Ocluded (99) 6 7.5%
Total 49 61.3%
Proneal artery Mild (50-70) 24 30%
Moderate (70-90) 11 13.7%
Severe (>90) 0 0
Near Ocluded (99) 0 0
Total 35 43.7%
Dorsalis pedis artery Mild (50-70) 17 21.3%
Moderate (70-90) 9 11.3%
Severe (>90) 0 0
Near Ocluded (99) 0 0
Total 26 32.5%
Tab.2  
Vessels Mean Std. Deviation Minimum Maximum
Superficial femoral artery 181.42 31.47 133 224
Popliteal artery 16.57 2.4 12 19
Anterior Tibialis artery 132.43 42.09 78 201
Posterior Tibialis artery 110.36 35.21 22 192
Proneal artery 107.51 14.83 68 137
Dorsalis pedis artery 42.26 7.23 30 52
Tab.3  
Outcomes Frequency Percent
Adverse Effects None 73 91.3%
Gi bleeding cuased by colopidogrol overdose (Expired) 3 3.8%
MI(expired) 3 3.8%
PTE(expired) 1 1.3%
Healing Comprelet healing 52 65%
Partial healing 6 7.5%
Non-healing 3 3.8%
Angioplasty not done 7 8.85
Relapse 5 6.3%
Expired 7 8.8%
Tab.4  
Fig.1  
Fig.2  
Variables Healing (n = 58) Non-healing (n = 15) P-value
Age 65.18±7.6 66.6±8.6 0.519
Gender Male 24(41.4%) 10(66.7%) 0.072
Female 34(58.6%) 5(33.3%)
Arteries Superficial 183.7273±30.32 172.4±30.32 0.32
Popliteal 17.3333±1.7 16 0.147
Anterior Tibialis 135.6667±37.32 155.7273±43.35 0.152
Posterioi Tibialis 101.0588±24.25 117.8125±35.05 0.055
Dorsalis 40.4444±5.7 40.6364±8.5 0.955
Proneal artery 105.13±8.93 109.64±11 0.295
BMI BMI>30 27(46.6%) 5(33.3%) 0.267
BMI<30 31(53.4%) 10(66.7%)
HTN Yes 40(69%) 11(73.3%) 0.5
No 18(31%) 4(26.7%)
Neuropathy Yes 12(20.7% 2(13.3%) 0.40
No 46(79.3%) 13(86.7%)
Nephropathy Yes 9(15.5%) 5(33.3%) 0.20
No 49(84.5%) 10(66.7%)
CAD Yes 33(56.9%) 13(86.7%) 0.11
No 25(43.1%) 2(13.3%)
CVA Yes 3(5.2%) 3(20%) 0.097
No 55(94.5%) 12(80%)
Hyperlipidemia Yes 38(65.5%) 9(60%) 0.4
No 20(34.5%) 6(40%)
Smoking Yes 16(27.6%) 9(60%) 0.02*
N0 42(72.4%) 6(40%)
Ulcer Size >5 25(43.1%) 8(53.3%) 0.33
<5 33(56.9%) 7(46.7%)
Tab.5  
Arteries B Sig. Odds ratio 95% C.I.for EXP(B)
Lower Upper
Superficial femoral artery 2.854 0.007 17.354 2.180 138.138
Popliteal artery 1.712 0.113 5.538 0.666 46.055
Anterior Tibialis artery -0.430 0.576 0.651 0.144 2.937
Posterior Tibialis artery 2.921 0.007 18.553 2.210 155.723
Proneal artery 1.100 0.151 1.467 0.631 11.530
Dorsalis pedis artery 2.600 0.013 13.467 1.729 104.910
Tab.6  
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