Background: Peripheral arterial disease (PAD) affects more than 200 million people with an ever-increasing prevalence. Faced with this public health issue, it seems crucial to take an interest in PAD management. In this study, we evaluated the predictors of major adverse lower limb events (MALEs) and wound healing following revascularization for chronic arterial trophic disorders in people with and without diabetes.
Methods: This retrospective study included all patients with Rutherford-Becker stage 5 or 6 who required a minor amputation in combination with a revascularization procedure in our vascular surgery department at Bordeaux University Hospital, from January 2016 to December 2018. The primary endpoint was MALEs. The secondary endpoints were wound healing at 6 months and 2 years, in-hospital and all-cause mortality.
Results: We included 241 patients, 180 with diabetes (74,7%) , with an average age of 74 years, 79,7% men. According to the Wound, Ischemia and foot Infection classification, 95,9% were ranked clinical stage 4, and to the TransAtlantic Inter-Society Consensus for the management of PAD (TASC) below-the-knee classification, 50,7% were stage C/D. Among patients with diabetes, 63,3% had post-operative uncontrolled diabetes. One-hundred seven MALEs occurred during 2-year follow-up (estimated rate of patients free of MALEs 48,7%, 95% CI: 41,7-55,4) , 78 MALEs in patients with diabetes. Revascularization failure predicted the occurrence of MALEs in multivariate analysis, while the lack of revascularization option predicted major amputation. Wound healing was adversely affected by haemodialysis, TASC C/D below-the-knee lesions, the number of bacteria, and reocclusion of the target artery. The in-hospital mortality rate was 5,4% and the overall 2-year mortality rate was 22,8%.
Conclusion: This study highlights the necessity to provide optimal revascularization associated with comprehensive medical care using multidisciplinary approaches to those patients affected by PAD.
V.Vosgin-dinclaux: None. K.Mohammedi: Board Member; Lilly, Novo Nordisk, Sanofi, Research Support; Cyclerion Therapeutics, Inc., Speaker's Bureau; Abbott, AstraZeneca. C.Caradu: None.