Swedish Study Shows Early Revascularization Improves Healing of Ischemic Foot Ulcers

August 5, 2014—A new study conducted at Skåne University Hospital in Malmö, Sweden, demonstrated that early revascularization after admittance to a diabetic foot center improves the healing probability of ischemic foot ulcer in patients with diabetes. The study by Targ Elgzyri, MD, et al is available online ahead of print in the European Journal of Vascular and Endovascular Surgery (EJVES).

In the background of the study, the investigators stated that there is limited information about whether time from recognition of decreased perfusion to revascularization affects the probability of healing in a patient with a diabetic foot ulcer. The aim of this study was to examine whether time to revascularization after referral to a multidisciplinary foot center was related to the outcome of foot ulcers in patients with diabetes and severe peripheral arterial disease.

As summarized in EJVES, patients with diabetes, a foot ulcer, and a systolic toe pressure < 45 mm Hg or an ankle pressure < 80 mm Hg were prospectively included at the foot center and considered for revascularization according to a preset protocol. All patients underwent invasive revascularization, either percutaneous transluminal angioplasty or reconstructive vascular surgery. All patients had continuous follow-up until healing or death irrespective of the type of revascularization.

The investigators reported that a total of 478 patients were included (age, 74 [range, 66–80] years; 60% men), of whom 315 patients (66%) had percutaneous transluminal angioplasty and 163 (34%) had reconstructive surgery. Of the 478 patients, 217 (45%) healed primarily, 88 (19%) healed after a minor amputation, 76 (16%) healed after a major amputation, and 92 patients (19%) died unhealed. The median time from inclusion in the study to revascularization was 8 weeks (3–18 weeks). Time to vascular intervention within 8 weeks (P < .001), maximum Wagner grade reached < 3 (P < .001), absence of peripheral edema (P = .033), and presence of intermittent claudication (P = .001) were related to a higher probability of healing.

Time to revascularization and extent of tissue damage were related to the probability of healing of ischemic foot ulcer in patients with diabetes over time. In the presence of a decreased perfusion in a patient with diabetes and a foot ulcer, not only revascularization per se but also the timing of revascularization is important for the possibility of healing without a major amputation, concluded the investigators in EJVES.