The strongest predictor of major amputation in diabetic foot ulcers: Peripheral arterial disease; frequency and related factors
Background and Aim: Diabetic foot ulcers and the resulting lower-extremity major amputations are common and mortal complications of diabetes. More than half of the diabetic foot ulcers are due to peripheral arterial disease. The aim of this study is to evaluate the frequency and related factors of peripheral arterial disease and to show the effect of peripheral arterial disease on major amputation for diabetic foot ulcers.
Methods: Follow-up forms of 123 diabetic foot patients who were treated at the chronic wound and infections care unit between September 2016 and August 2017 were evaluated retrospectively.
Results: Among the study patients, 65% of them were males and the mean age was 59.7±11.7. Peripheral arterial disease was present in 66.7% of the patients. During the treatment 13.8% of patients underwent major lower extremity amputation. According to multiple logistic regression analysis peripheral arterial disease was found to be higher 15.5-fold for the major amputation group. Significant correlations were found between peripheral arterial disease and hypertension (p<0.001), median age (p<0.001), diabetes duration (p=0.023), chronic kidney disease (p=0.042) and HbA1c (p=0.003).
Conclusions: We found in this study that peripheral arterial disease is very common in patients with diabetic foot ulcers and the major amputation rates increase with peripheral arterial disease presence. Therefore for all the patients with diabetic foot ulcers, peripheral arterial disease should be investigated and the treatments should be planned rapidly.
- Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet 2003;361 (9368):1545–51.
- Brownrigg JRW, Apelqvist J, Bakker K, Schaper NC, Hinchliffe RJ. Evidence-based management of PAD & the diabetic foot. Eur J Vasc Endovasc Surg 2013;45(6):673-81.
- Armstrong DG, Cohen K, Courric S, Bharara M, Marston W. Diabetic foot ulcers and vascular insufficiency: our population has changed, but our methods have not. J Diabetes Sci Technol 2011;5(6):1591-95.
- Davis WA, Norman PE, Bruce DG, Davis TME. Predictors, consequences and costs of diabetes-related lower extremity amputation complicating type 2 diabetes: The Fremantle Diabetes Study. Diabetologia 2006; 49: 2634–41.
- Breshow A, Slesaczeck T, Münch D, Nanning T, Paetzold H, Schwanebeck U, et al. Improving major amputation rates in the multicomplex diabetic foot patient: focus on the severity of peripheral arterial disease. Ther Adv Endocrinol Metab 2013;4(3):83–94.
- Prompers L, Schaper N, Apelqvist J, Edmonds M, Jude E, Mauricio D et al. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study. Diabetologia 2008; 51: 747-55.
- Lipsky B, Berendt A, Cornia P, Pile J, Peters E, Armstrong D et al. 2012 Infectious diseases society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. J Am Podiatr Med Assoc 2013; 103: 2-7.
- Faglia E, Clerici G, Mantero M, et al. Incidence of critical limb ischemia and amputation outcome in contralateral limb in diabetic patients hospitalized for unilateral critical limb ischemia during 1999-2003 and followed-up until 2005. Diabetes Res Clin Pract 2007; 77(3): 445-50.
- Schaper NC, Andros G, Apelqvist J, Bakker K, Lammer J, Lepantalo M et al. Diagnosis and treatment of peripheral arterial disease in diabetic patients with a foot ulcer. A progress report of the International Working Group on the Diabetic Foot. Diabetes Metab Res Rev 2012; 28(Suppl 1): 218–24.
- Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg 2007;33(Supp 1):1-75.
- Saltoğlu N, Kılıçoğlu Ö, Baktıroğlu S et al. Diyabetik ayak yarası ve infeksiyonunun tanısı, tedavisi ve önlenmesi: Ulusal uzlaşı raporu. Klimik Derg 2015; 28(Suppl.1):2-34.
- Unwin N. Comparing the incidence of lower extremity amputations across the world: the global lower extremity amputation study. Diabet Med 1995; 12: 14-18.
- Richard J, Lavigne J, Got I, Hartemann A, Malgrange D, Tsirtsikolou D, et al. Management of patients hospitalized for diabetic foot infection: results of the French OPIDIA study. Diabetes Metab 2011; 37: 208–15.
- Aysert YP, Özdil T, Dizbay M, Güzel Tunçcan Ö, Hızel K. Peipheral arterial disease increases the risk of multidrug-resistant bacteria and amputation in diabetic foot infections. Turk J Med Sci 2018;48:845-50.
- Lacroix P, Aboyans V, Desormais I, Kowalsky T, Cambou JP, Constans J, et al. Chronic kidney disease and the short-term risk of mortality and amputation in patients hospitalized for peripheral artery disease. J Vasc Surg 2013; 58 (4): 966-71.
- Saleem S, Hayat N, Ahmed I, Ahmed T, Rehan AG. Risk factors associated with poor outcome in diabetic foot ulcer patients. Turk J Med Sci 2017; 47: 826-31.
- Yesil S, Akinci B, Yener S, Bayraktar F, Karabay O, Havitcioglu H, et al. Predictors of amputation in diabetics with foot ulcer: Single center experience in a large Turkish cohort. Hormones 2009; 8(4):286-95.