Characteristics and Outcome for Persons with Diabetic Foot Ulcer and No-Option Critical Limb Ischemia

Abstract

The study aimed to evaluate clinical and vascular characteristics, as well as outcomes, for diabetic persons with foot ulceration and no-option critical limb ischemia (CLI). The study group included a sample of patients admitted to our diabetic foot unit because of a new diabetic foot ulcer and CLI. All subjects were managed using a limb salvage protocol which includes lower-limb revascularization. According to whether or not the revascularization procedure was a success, patients were respectively divided into two groups: successfully treated CLI patients (ST-CLI) and no-option CLI patients (NO-CLI). Failed revascularization was considered in the case of technical recanalization failure of occluded vessels (inability to overcome the obstruction) and/or absence of arterial flow to the foot. Limb salvage, major amputation, and death after 1 year of follow-up were evaluated and compared between the two groups. Overall, 239 patients were included, 74.9% belonging to ST-CLI and 25.1% to NO-CLI. NO-CLI patients reported more cases of ischemic heart disease (80 vs. 62.1, <i>p</i> = 0.008), heart failure (63.3 vs. 32.4%, <i>p</i> < 0.0001), and end-stage renal disease (ESRD) (60 vs. 25.7%) than ST-CLI patients. In addition, more vessels were affected in the NO-CLI group (5.2 ± 1.6 vs. 4 ± 1.5, <i>p</i> < 0.0001), and there was more involvement of tibio-peroneal trunk (50 vs. 30.2%, <i>p</i> = 0.006), anterior tibial (93.3 vs. 82.7, <i>p</i> = 0.03), posterior tibial (93.3 vs. 73.7%, <i>p</i> = 0.0005), peroneal (70 vs. 48%, <i>p</i> = 0.002), and below-the-ankle arteries (73.3 vs. 39.1%, <i>p</i> < 0.0001) than ST-CLI. The 1 year outcomes for the whole population were 69.9% limb salvage, 10.9% major amputation, and 19.2% death. The outcomes for NO-CLI and ST-CLI were, respectively, as follows: limb salvage (13.8 vs. 73.4%, <i>p</i> < 0.0001), amputation (30 vs. 4.5%, <i>p</i> = 0.0001), and mortality (50 vs. 8.9%, <i>p</i> < 0.0001). NO-CLI patients showed a more severe pattern of peripheral arterial disease (PAD) with distal arterial lesions and worse outcomes than ST-CLI.