February 17, 2020
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‘No difference’ between endovascular, open vascular surgeries for diabetic foot ulcers

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Adults with diabetic foot ulcers and peripheral artery disease who receive revascularization surgery are at no greater risk for amputation or death following endovascular surgery compared with open vascular surgery, according to findings published in the Journal of Diabetes and its Complications.

“The present large cohort study showed in a propensity score-adjusted analysis that there was no difference in amputation-free survival in patients with diabetic foot ulcers and peripheral arterial disease regardless of whether endovascular or open vascular surgery was chosen as first-line vascular intervention,” Talha Butt, MD, of the department of cardiothoracic and vascular surgery at Skåne University Hospital in Sweden, and colleagues wrote. “The present study is therefore an important contribution to the evaluation of possible long-term outcome differences after endovascular vascular vs. open vascular surgery in this challenging and complex patient group.”

Butt and colleagues used data from 376 adults with diabetic foot ulcers and peripheral artery disease (median age, 74 years; 40% women) to asses amputation frequency and mortality across 2.7 years of median follow-up after revascularization surgery. Endovascular surgery was conducted on 289 limbs and open vascular surgery was conducted on 119 limbs, as some participants required surgery on multiple limbs. The researchers used the National Population Register to confirm deaths during follow-up.

Among those who had endovascular surgery, 17% had a major amputation during follow-up, whereas 16.8% of those who had open vascular surgery required an amputation. In addition, among those who had endovascular surgery, there was a 43.1% mortality rate while those who had open vascular surgery had a 46.5% mortality rate. The researchers noted that despite these findings, there was “no difference” between the groups in either amputation or mortality and that amputation was more frequently required due to “longer time to intervention.”

“According to this report, diagnostics in suspected foot ischemia among patients with diabetic foot ulcers should be organized rapidly to ensure revascularization within 2 weeks from the first evaluation and consequently improve limb salvage rate,” the researchers wrote. “The present study confirms that longer time to intervention was associated with increased major amputation rate.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.