European Journal of Vascular & Endovascular Surgery
Volume 32, Issue 5 , Pages 484-490 , November 2006

Early and Five-year Amputation and Survival Rate of Diabetic Patients with Critical Limb Ischemia: Data of a Cohort Study of 564 Patients

  • E. Faglia

      Affiliations

    • Diabetology Centre-Diabetic Foot Centre
    • Corresponding Author InformationCorresponding author. E. Faglia, Diabetology Centre-Diabetic Foot Centre, Policlinico MultiMedica, Via Milanese 300, 20099 Sesto San Giovanni (Milan), Italy.
    web address
  • ,
  • G. Clerici

      Affiliations

    • Diabetology Centre-Diabetic Foot Centre
  • ,
  • J. Clerissi

      Affiliations

    • Interventional Radiology Laboratory, Policlinico Multimedica, Sesto San Giovanni (Milano), Italy
  • ,
  • L. Gabrielli

      Affiliations

    • Vascular Surgery
  • ,
  • S. Losa

      Affiliations

    • Vascular Surgery
  • ,
  • M. Mantero

      Affiliations

    • Diabetology Centre-Diabetic Foot Centre
  • ,
  • M. Caminiti

      Affiliations

    • Diabetology Centre-Diabetic Foot Centre
  • ,
  • V. Curci

      Affiliations

    • Diabetology Centre-Diabetic Foot Centre
  • ,
  • T. Lupattelli

      Affiliations

    • Interventional Radiology Laboratory, Policlinico Multimedica, Sesto San Giovanni (Milano), Italy
  • ,
  • A. Morabito

      Affiliations

    • Medical Statistics Unit, University of Milan, Italy

,Accepted 14 March 2006.

References 

  1. LoGerfo FW, Gibbons GW, Pomposelli FB, Campbell DR, Miller A, Freeman DV, et al. Trends in the care of the diabetic foot. Expanded role of arterial reconstruction. Arch Surg. 1992;127:617–620
  2. Holstein P, Ellitsgaard N, Olsen BB, Ellitsgaard V. Decreasing incidence of major amputations in people with diabetes. Diabetologia. 2000;43:844–847
  3. Pomposelli FB, Marcaccio EJ, Gibbons GW, Campbell DR, Freeman DV, Burgess AM, et al. Dorsalis pedis arterial bypass: durable limb salvage for foot ischemia in patients with diabetes mellitus. J Vasc Surg. 1995;21:375–384
  4. Holstein P, Sorensen S. Limb salvage experience in a multidisciplinary diabetic foot unit. Diabetes Care. 1999;22(Suppl 2):B97–B103
  5. TransAtlantic Inter-Society (TASC): management of peripheral arterial disease (PAD). Eur J Vasc Endovasc Surg. 2000;19(Suppl A):208–290
  6. Faglia E, Dalla Paola L, Clerici G, Clerissi J, Graziani L, Fusaro M, et al. Peripheral angioplasty as the first-choice revascularization procedure in diabetic patients with critical limb ischemia: prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003. Eur J Vasc Endovasc Surg. 2005;29:620–627
  7. Garbalosa JC, Cavanagh PR, Wu G, Ulbrecht JS, Becker MB, Alexander IJ, et al. Foot function in diabetic patients after partial amputation. Foot Ankle Int. 1996;17:43–48
  8. Reyzelman AM, Hadi S, Amstrong DG. Limb salvage with Chopart's amputation and tendon balancing. J Am Podiatr Med Assoc. 1999;89:100–103
  9. Grollman J, Levin DC, Bettmann MA, Gomes AS, Henkin RE, Hessel SJ, et al. Recurrent symptoms following lower extremity angioplasty: claudication and threatened limb. American College of Radiology. ACR Appropriateness Criteria. Radiology. 2000;215(Suppl):95–99
  10. Isner JM, Rosenfield K. Redefining the treatment of peripheral artery disease. Role of percutaneous revascularization. Circulation. 1993;88:1534–1557
  11. ACR-appropriateness criteria™ for recurrent symptoms following lower extremities arterial bypass surgery. Radiology. 2000;215:89–93
  12. Rayman G, Krishan TM, Baker NR, Wareham AM, Rayman A. Are we underestimating diabetes-related lower-extremity amputation rates?. Diabetes Care. 2004;27:1892–1896
  13. Bypass versus angioplasty in severe ischemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005;366:1925–1934
  14. Faglia E, Mantero M, Caminiti M, Caravaggi C, De Giglio R, Pritelli C, et al. Extensive use of peripheral angioplasty, especially infrapopliteal, in the treatment of ischemic foot ulcer: clinical results of a multicentric study of 221 consecutive diabetic subjects. J Intern Med. 2002;252:225–232
  15. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL et al. ACC/AHC Guidelines for the Management of Patients with Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic). A Collaborative Report from the American Association for Vascular Surgery/Society of Vascular Surgery, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHC Task Force on érectice Guidelines (Writing Committee to Develop Guidelines for the management of Patients With Peripheral Arterial Disease). American College of Cardiology Web Site, 2.6.3.2 Endovascular treatments for CLI, 2005, p. 65–66.
  16. Virkkunen J, Heikkinen M, Lepantalo M, Metsanoja R, Salenius JP The Finvasc Study Group. Diabetes as an independent risk factor for early postoperative complications in critical limb ischemia. J Vasc Surg. 2004;40:761–767
  17. Levin ME. Preventing amputation in the patient with diabetes. Diabetes Care. 1995;18:1383–1394
  18. Ouriel K. Peripheral arterial disease. Lancet. 2001;358:1257–1264
  19. Campbell WB, Ponette D, Sugiono M. Long-term results following operation for diabetic foot problems: arterial disease confers a poor prognosis. Eur J Vasc Endovasc Surg. 2000;19:174–177
  20. Lepantalo M, Biancari F, Tukiainen E. Never amputate without consultation of a vascular surgeon. Diabetes Metab Res Rev. 2000;16(Suppl 1):S27–S32
  21. Hunter GA. Results of minor foot amputations for ischemia of the lower extremity in diabetics and non diabetics. Can J Surg. 1975;18:273–276
  22. Yeager RA, Moneta GL, Edwards JM, Williamson K, McConnell DB, Taylor LM, et al. Predictors of outcome of forefoot surgery for ulceration and gangrene. Am J Surg. 1998;175:388–390
  23. Panneton JM, Gloviczki P, Bower TC, Rhodes JM, Canton LG, Toomey BJ. Pedal bypass for limb salvage: impact of diabetes on long-term outcome. Ann Vasc Surg. 2000;14:640–647
  24. Domenig CM, Hamdan AD, Holzenbein TJ, Kansal N, Aulivola B, Skillman JJ, et al. Timing of pedal bypass failure and its impact on the need for amputation. Ann Vasc Surg. 2005;19:56–62
  25. Jude EB, Oyibo SO, Chalmers N, Boulton AJ. Peripheral arterial disease in diabetic and nondiabetic patients. A comparison of severity and outcome. Diabetes Care. 2001;24:1433–1437
  26. van der Feen C, Neijens FS, Kanters SD, Mali WP, Stolk RP, Banga JD. Angiographic distribution of lower extremity atherosclerosis in patients with and without diabetes. Diabet Med. 2002;19:366–370
  27. Moulik PK, Mtonga R, Gill GV. Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology. Diabetes Care. 2003;26:491–494
  28. Criqui MH, Denemberg JO. The generalized nature of atherosclerosis: how peripheral arterial disease may predict adverse events from coronary artery disease. Vasc Med. 1998;3:241–245
  29. Boyko EJ, Ahroni JH, Smith DG, Davignon D. Increased mortality associated with diabetic foot ulcer. Diabet Med. 1996;13:967–972
  30. Leibson CL, Ramsom JE, Olson W, Zimmerman BR, O'Fallon WM, Palumbo PJ. Peripheral Arterial Disease, Diabetes, and Mortality. Diabetes Care. 2004;27:2843–2849
  31. Bertele V, Roncaglioni MC, Pangrazzi J, Terxzian E, Tognoni G on the behalf of the “i.c.a.i.” (CLI) Group. Clinical outcome and its predictors in 1560 patients with critical leg ischemia. Eur J Vasc Endovasc Surg. 1999;18:401–410
  32. Petrakis IE, Sciacca V. Spinal cord stimulation in diabetic lower limb critical ischaemia: transcutaneous oxygen measurement as predictor for treatment success. Eur J Vasc Endovasc Surg. 2000;19:587–592

PII: S1078-5884(06)00159-6

doi: 10.1016/j.ejvs.2006.03.006

European Journal of Vascular & Endovascular Surgery
Volume 32, Issue 5 , Pages 484-490 , November 2006