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BACKGROUND/OBJECTIVES: To analyze the best noninvasive tests prognosis marker in patients with diabetic foot ulcer (DFU) who underwent endovascular revascularization based on clinical outcomes, such as healing rate, time to heal, and free amputation survival after at least a six-month follow-up. METHODS: A multicentric prospective observational study was performed with 28 participants with ischemic or neuroischemic DFU who came to the participant centers and underwent endovascular revascularization between January 2022 and March 2023. Toe systolic pressure (TP), ankle systolic pressure (AP), the ankle brachial pressure index (ABPI), the toe brachial pressure index (TBPI), transcutaneous pressure of oxygen (TcPO2), and skin perfusion pressure (SPP) were evaluated using PeriFlux 6000 System, Perimed, Sweden, before (Visit 0) and four weeks after revascularization (Visit 1). The primary clinical outcome was an evaluation of the clinical evolution of noninvasive tests comparing Visit 0 and Visit 1, estimating the sensitivity for predicting wound healing of noninvasive tests at six months following initial recruitment. RESULTS: After six months, 71.43% (n = 20) of DFU healed, four patients (14.3%) received major amputations, and one (3.5%) died. The two tests that best predicted wound healing after revascularization according to the ROC curve were TcPO2 and TP with sensitivities of 0.89 and 0.70 for the cut-off points of 24 mmHg and 46 mmHg, respectively. CONCLUSIONS: TcPO2 and TP were the two tests that best predicted wound healing in patients who underwent endovascular revascularization. Clinicians should consider the importance of the evaluation of microcirculation in the healing prognosis of patients with diabetic foot ulcers.
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INTRODUCTION: Patients with deep vein thrombosis affecting the iliac and vena cava veins develop a more severe post-thrombotic syndrome than those with femoropopliteal disease. It has been traditionally treated only with medical therapy. During the last decade, endovascular repair has become the treatment of choice. The aim of this study is to report our midterm results using this technique. METHODS: From 2009 to 2012, 41 limbs in 36 patients with post-thrombotic chronic flow obstruction of iliofemoral vein secondary to stenotic or occlusive lesions and with a clinical CEAP class 3 or higher or venous pain underwent percutaneous treatment. Stent-related outcome (patency and thrombotic events), clinical outcome (improvement of revised Venous Clinical Severity Score [VCSS] and Villalta score) were evaluated after intervention. RESULTS: The procedure was successful in 39 limbs (95%) with no mortality and low morbidity. Thrombotic events occurred in nine limbs (23%) during the follow-up period. At 33 months, primary, assisted-primary, and secondary cumulative patency rates were 74%, 87%, and 89%, respectively. The main risk factor associated with stent occlusion was the severity of thrombotic disease. All postoperative thrombotic events occurred in occluded veins; no previously stenotic veins presented any complication (P = .04). Presence of thrombophilia, stent brand, and stent extension into the common femoral vein were not significantly associated with stent thrombosis. After surgery, the mean revised VCSS and Villalta scores improved substantially (P < .0001). The cumulative rate of revised VCSS improvement was 89% at 33 months. Clinical improvement was observed despite deep venous system reflux remaining uncorrected. CONCLUSIONS: Percutaneous treatment of post-thrombotic venous flow obstruction is an excellent therapeutic option with low morbidity and no mortality. It can be performed with high midterm patency rates and midterm clinical improvement.
