Predictive Factors of Wound Healing and Limb Salvage After Successful Below-the-Knee Endovascular Angioplasty in Patients with Diabetic Foot Ulcer: A Retrospective Study.

Abstract

Background and Objectives: The primary objective of this study was to determine the predictive factors of limb salvage and wound healing in patients presenting with diabetic foot ulcers (DFUs) following successful below-the-knee endovascular angioplasty. Materials and Methods: Between January 2014 and January 2019, we retrospectively analyzed the wound healing and limb salvage rates of 85 patients (88 limbs) who underwent infra-popliteal endovascular treatment (EVT) for DFUs. Numerous variables were explored, including age, sex, comorbidities, and the scores from three DFU grading systems (Wagner grade, University of Texas (UT) grade and stage, and Wound, Ischemia, and foot Infection (WIfI) stage). Univariate and multivariate Cox proportional hazards analyses were conducted to determine the associations between adverse events and these variables. Results: During follow-up, 44 wounds healed completely, 47 limb amputations (major, 25; minor, 22) were required, and 17 limbs needed reintervention for wound healing. Nine patients who received treatment died of cardiovascular and cerebrovascular diseases, pneumonia, and other causes. At 1, 3, 6, 9, and 12 months, total wound healing rates were 4.6%, 16.9%, 27.5%, 34.5%, and 64.5%, respectively. At 6 months, 1 year, 2 years, and 5 years, amputation-free survival rates were 77.6%, 72.4%, 63.3%, and 63.3%, respectively. In multivariate Cox analyses, the UT grade and stage were associated with increased wound non-healing, while the UT grade and Wagner grade were associated with increased major lower-extremity amputation rates. Importantly, the UT grade was the only simultaneous risk factor predicting both wound healing and limb salvage. Conclusions: Despite successful below-the-knee angioplasty, a significant proportion of patients experienced wound non-healing and major amputation. The UT grade may serve as a predictor for both wound healing and limb salvage outcomes.