Journal List > J Korean Foot Ankle Soc > v.22(1) > 1043458

Im, Lee, Kang, Cho, Jo, and Lee: Usefulness of Percutaneous Transluminal Angioplasty before Operative Treatment in Diabetic Foot Gangrene



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.


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).


Preoperative percutaneous angioplasty in diabetic foot gangrene patients with peripheral vascular occlusive disease is simple, and 59.2% of the patients with diabetic foot gangrene could be treated by conservative treatment or debridement.


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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
Grade Lesion
0 Pressure area on foot aggrevated by foot wear
1 Open but superficial ulceration
2 Full thickness ulceration
3 Full thickness ulceration with secondary infection
4 Local gangrene
5 Extensive gangrene, entire foot
Table 2.
Stenosis Location by Angiography
Location of stenosis No. of patients
Proximal Superficial femoral artery 10
Popliteal artery 1
ATA 21
Distal Distal DPA 17
Distal PTA 19

ATA: anterior tibialis artery, PTA: posterior tibialis artery, DPA: dorsalis pedis artery.

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

Values are presented as number only. SFA: superficial femoral artery, PA: popliteus artery, ATA: anterior tibialis artery, PTA: posterior tibialis artery, DPA: dorsalis pedis artery, dPTA: distal PTA.

Table 5.
Final Treatments after Angioplasty according to the Lengths of the Proximal ATA & PTA Stenosis
Location Length of stenosis (cm) No. of cases Treatment p-value
Conservative Debridement Amputation
ATA <5 2 2 0 0 0.23
5∼10 9 2 5 2 0.59
>10 10 7 2 1 0.48
PTA <5 2 1 1 0 0.21
5∼10 3 0 1 2 0.35
>10 1 0 0 1 0.43

Values are presented as number only. ATA: anterior tibialis artery, PTA: posterior tibialis artery.

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