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Abstract
Purpose:
Diabetic foot gangrene has a high morbidity rate and a great influence on the quality of life. Amputation is an appropriate treatment if conservative treatment is impossible according to the severity of gangrene and infection. The purpose of this study was to evaluate the usefulness of preoperative percutaneous transluminal angioplasty for the postoperative outcome.
Materials and Methods:
From February 2013 to April 2016, among 55 patients with diabetic foot gangrene, who require surgical treatment, percutaneous transluminal angioplasty was performed on patients with an ankle brachial index (0.9 and stenosis) 50% on angiographic computed tomography. The study subjects were 49 patients, comprised of 37 males (75.5%) and 12 females (24.5%). The mean age of the patients was 70.0±9.6 years. The treatment results were followed up according to the position and length of the lesion and the changes during the follow-up period.
Results:
As a result of angiography, there were 13 cases of atherosclerotic lesions in the proximal part, 11 cases in the distal part and 25 cases in both the proximal and distal parts. As a result of the follow-up after angiography, in 13 patients, the operation was not performed and only follow-up and dressing were performed around the wound. Sixteen patients underwent debridement for severe gangrene lesions and 20 patients, in whom the gangrene could not be treated, underwent amputation (ray amputation or metatarsal amputation, below knee amputation).
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Figure 1.
Angiography before (A) and after (B) intervention of anterior tibial artery and superficial femoral arteries. Blood flow was restored after the intervention.
Figure 2.
(A) Diabetic gangrene with ischemia and infection. (B) Fourteen days after balloon dilatation of peripheral artery.
Table 1.
Wagner’s Diabetes Mellitus Foot Classification
Table 2.
Stenosis Location by Angiography
| Location of stenosis | No. of patients | |
|---|---|---|
| Proximal | Superficial femoral artery | 10 |
| Popliteal artery | 1 | |
| ATA | 21 | |
| PTA | 6 | |
| Distal | Distal DPA | 17 |
| Distal PTA | 19 |
Table 3.
Final Treatment of Diabetes Mellitus Foot after Percutaneous Transluminal Angioplasty
| Treatment | No. of patients (%) |
|---|---|
| Conservative management | 13 (26.5) |
| Debridement | 16 (32.7) |
| Amputation | 20 (40.8) |
Table 4.
Results of Arterial Territory according to the Different Regions of Artery
| Conservative | Debridement | Amputation | p-value | |
|---|---|---|---|---|
| SFA stenosis | 2 | 7 | 1 | 0.68 |
| PA stenosis | 0 | 0 | 1 | 0.74 |
| ATA stenosis | 11 | 7 | 3 | 0.78 |
| PTA stenosis | 1 | 2 | 3 | 0.17 |
| DPA stenosis | 6 | 4 | 7 | 0.47 |
| dPTA stenosis | 3 | 4 | 12 | 0.68 |
Table 5.
Final Treatments after Angioplasty according to the Lengths of the Proximal ATA & PTA Stenosis
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