Chronic Limb-Threatening Ischemia in Patients with Type 2 Diabetes: Revascularization Index as a Predictor for Primary Endovascular Intervention Outcome.

Purpose: Chronic limb-threatening ischemia in patients with diabetes is associated with a high risk of adverse outcomes. The associated co-morbidities, the heterogeneity of foot presentation and the distribution of atherosclerotic lesions led to the emergence of multiple revascularization strategies and scoring systems to improve management outcomes. This study aimed to introduce a new index, the revascularization index (RI), and to assess its predictive value for the outcomes of primary endovascular intervention in patients with type 2 diabetes presenting with chronic limb-threatening ischemia. Patients and Methods: A retrospective electronic medical records review was conducted for patients with type 2 diabetes presenting with chronic limb-threatening ischemia managed at King Abdullah University Hospital by primary endovascular interventions between January 2014 and August 2019. The RI was analyzed for its predictive value for the treatment outcomes. Results: A total of 187 patients were included in this study, with a major lower limb amputation rate of 19.3%. The performance of the RI was excellent in predicting secondary revascularization (AUC = 0.80, 95% CI: 0.73-0.86, p-value < 0.001), good to predict major amputation (AUC = 0.76, 95% CI: 0.67-0.85, p-value = 0.047), and poor in predicting death (AUC = 0.46, 95% CI: 0.40-0.55, p-value = 0.398). RI of <1.21 was significantly associated with a higher risk of major lower limb amputation (HR = 5.8, 95% CI: 1.25-26.97, p-value < 0.025), and RI of < 1.3 was associated with a higher risk for secondary revascularization. Conclusion: The RI can be used to predict major adverse lower limb events (MALE). It might be used as a guide for the extent of endovascular interventions for diabetic chronic limb-threatening ischemia with multi-level outflow atherosclerotic disease.

Nonhealing Leg Ulcer as the Presentation of Sarcoidosis: A Case Report.

Chronic leg ulcers (CLUs) are common, with increasing prevalence in the elderly population. Circulatory dysfunctions are responsible for 90% to 95% of all causes, while 5% to 10% of CLUs are associated with underlying chronic systemic disorders. Sarcoidosis is a complex multisystemic disease characterized by noncaseating granulomas affecting mainly the pulmonary system, with cutaneous manifestation in 25% to 30% of cases. However, ulcerative sarcoidosis (US) is a rare form of cutaneous sarcoidosis. Pyoderma gangrenosum (PG) is an uncommon, chronic inflammatory noninfectious skin disease affecting different body parts. The ulcerative form of PG is rarely reported in association with sarcoidosis.We aim to report a 44-year-old female patient with a history of hypertension and varicose veins, presenting with a CLU for more than 18 months. Ulcer tissue biopsy showed noncaseating granuloma with abscess formation suggestive of sarcoidosis; however, PG could not be ruled out. Mediastinal lymph node biopsy was consistent with sarcoidosis. The leg ulcer had complete healing within 4 months by local wound management, negative pressure wound therapy, and split-thickness skin grafting without immunosuppressive treatment to achieve wound healing.