February 6, 2020
Outcomes of Endovascular and Open Surgery Strategies Compared in Patients with Diabetic Foot Ulcer and PAD
February 6, 2020—Findings from a study comparing outcomes of endovascular surgery versus open vascular surgery in patients with diabetic foot ulcer (DFU) and peripheral artery disease (PAD) were published online ahead of print by Talha Butt, MD, et al in Journal of Diabetes and its Complications.
The investigators concluded, “[T]he endovascular surgery–first strategy and open vascular surgery–first strategy were associated with similar long-term results in a large cohort of patients with DFU and PAD undergoing revascularization. Rapid revascularization reduces the risk of amputation.”
According to the investigators, 1,151 patients with DFU were admitted to the diabetic foot care team between 1984 and 2006. There were 376 patients with 408 limbs consecutively included at a multidisciplinary foot center; 289 limbs were treated with endovascular surgery and 119 limbs with an open vascular surgery–first strategy. A propensity score–adjusted analysis was performed to compare outcomes for type of revascularization.
As summarized in Journal of Diabetes and its Complications, major amputation rates were 17% after endovascular surgery and 16.8% after open vascular surgery (P = .97) at 3 years. Mortality was 43.1% after endovascular surgery and 46.5% after open vascular surgery (P = .55).
In the propensity score–adjusted analysis, patients undergoing endovascular surgery first had similar outcomes in terms of major amputation, mortality, and combined major amputation/mortality compared with those undergoing open vascular surgery. A longer time to intervention (P = .003) was associated with an increased major amputation rate in the multivariable Cox regression analysis, reported the investigators in Journal of Diabetes and its Complications.