Effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral artery disease: a systematic review

Abstract

Symptoms or signs of peripheral artery disease (PAD) can be observed in up to 50% of the patients with a diabetic foot ulcer and is a risk factor for poor healing and amputation. In 2012, a multidisciplinary working group of the International Working Group on the Diabetic Foot published a systematic review on the effectiveness of revascularization of the ulcerated foot in patients with diabetes and PAD. This publication is an update of this review and now includes the results of a systematic search for therapies to revascularize the ulcerated foot in patients with diabetes and PAD from 1980 to June 2014. Only clinically relevant outcomes were assessed. The research conformed to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and Scottish Intercollegiate Guidelines Network methodological scores were assigned. A total of 56 articles were eligible for full-text review. There were no randomized controlled trials, but there were four nonrandomized studies with a control group. The major outcomes following endovascular or open bypass surgery were broadly similar among the studies. Following open surgery, the 1-year limb salvage rates were a median of 85% (interquartile range of 80-90%), and following endovascular revascularization, these rates were 78% (70-89%). At 1-year follow-up, 60% or more of ulcers had healed following revascularization with either open bypass surgery or endovascular techniques. Studies appeared to demonstrate improved rates of limb salvage associated with revascularization compared with the results of conservatively treated patients in the literature. There were insufficient data to recommend one method of revascularization over another. There is a real need for standardized reporting of baseline demographic data, severity of disease and outcome reporting in this group of patients.

A Critical Evaluation of Existing Diabetic Foot Screening Guidelines

“…Guideline and grading adopted from SIGN risk stratification system Legend: * Guideline based on 7 systematic reviews created by IWGDF working groups. The reviews are related to different topics: 1) prevention [22], 2) footwear [23], 3) PAD diagnosis [24], 4) PAD prognosis [25], 5) PAD therapy [26], 6) infection [27], and 7) wound healing [28]. Each group applied its own grading system, usually either the GRADE or the SIGN system.…”

Manual and documents of International Working Group on the Diabetic Foot 2015 for prevention and treatment of diabetic foot diseases: the achievement of argumentative consensus (Russian cut version)

“…Результаты этой работы имеются в свободном доступе в журнале Diabetes / Metabolism Research and Reviews [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23].…”

Hard-to-heal diabetes-related foot ulcers: current challenges and future prospects

“…98 As a guide, patients with DFU will generally heal if toe pressure is >55 mmHg 92 but should be promptly referred for further vascular imaging and revascularization if toe pressure is <30 mmHg. 99 Irrespective of noninvasive …”

“…99 Literature to date does not provide a definitive guide to which patients will benefit most from revascularization or whether open bypass or endovascular procedures are optimal. However, the recent review by the IWGDF indicates that overall ~60% of ulcers when revascularized proceed to heal.…”

“…However, the recent review by the IWGDF indicates that overall ~60% of ulcers when revascularized proceed to heal. 99 The 1-year survival rates are 80%-90% for open bypass and 70%-85% following endovascular procedures. 91 Despite some variability in results, the increased accessibility to endovascular procedures provides a window of hope for healing of DFUs even if the resultant increased perfusion is temporary.…”