Endovascular Treatment of Diabetic Foot Syndrome: Results from a Single Center Prospective Registry Using Mixed Coronary and Peripheral Techniques and Equipment

Abstract

To assess the long-term results of interventional treatment of diabetic foot using mixed coronary and peripheral equipments and techniques. The interventional diabetic foot syndrome treatment is rapidly becoming the therapy of choice in such patients, but proper materials and techniques are still debated. From January 2006 to December 2010, we prospectively enrolled 220 diabetic patients (78.5 ± 15.8 years, 107 females, all with Fontaine III or IV class), referred to our center for diabetic foot syndrome and severe limb ischemia. Mixed coronary and peripheral guidewires and balloons techniques were used. Doppler ultrasonography and foot transcutaneous oxygen pressure (TCPO2) before and after the procedure were calculated as well as the amputation rate. The preferred approach was ipsilateral femoral antegrade in 170/220 patients (77.7%), contralateral cross-over in 40/220 patients (18.8%), and popliteal retrograde + femoral antegrade in 10/220 patients (4.5%). The techniques included combined use of coronary and dedicated peripheral guidewires and coronary and peripheral dedicated balloons. Balloon angioplasty was performed in 252 legs (32 patients with bilateral disease): the procedure was successful in 239/252 legs with an immediate success rate of 94.8% and a significant improvement in TCPO2 and ankle-brachial index with ulcer healing in 233/252 legs (92.4%). The freedom from major amputation was 82.8% at a mean follow-up of 3.1 ± 1.8 years (range 1 to 5 years). The endovascular diabetic foot syndrome treatment using mixed coronary and peripheral materials and techniques seems to lead to high immediate success and limb salvage rates compared to historical series.

Comparison of drug eluting balloon angioplasty to infrapopliteal artery critical lesions with or without additional pedal artery angioplasty in patients with diabetes mellitus and critical limb ischemia

“…EVT in diabetic patients with CLI may be challenging because of several factors such as the localization of lesions in BTA, calcified nature of very tight stenosis, which make the crossing by balloon catheter problematic. With using mixed coronary and peripheral materials and techniques seems to lead to high immediate success and limb salvage rates compared to historical series in a study . Through antegrade ipsilateral strategy we used semi‐compliant coronary balloon over hydrophilic guide wire for predilatation in BTA occlusions where we were unable to cross with standard peripheral balloons.…”

Effect of down-regulation of let-7c/g on triggering a double-negative feedback loop and promoting restenosis

“…[ 2 , 3 ] Percutaneous transluminal angioplasty (PTA) is the preferred treatment for diabetic LEAD and shows a high technical success rate. [ 4 ] However, restenosis (RS) limits the long-term clinical benefit of PTA. [ 5 ] Even with recent advances in the technical aspect of PTA, RS remains the most frequent cause of target lesion failure.…”