Autor(es): Rolo Santos, Catarina ; Cunha e Sá, Diogo ; R. Soares, Tony ; Gimenez, José ; Costa, Tiago ; Cabral, Gonçalo ; Tiago, José ; Duarte, Armanda
Data: 2025
Origem: Portuguese Journal of Cardiac Thoracic and Vascular Surgery
Assunto(s): diabetes; CLTI; distal revascularization; infrapopliteal; infragenicular; bypass; diabetic foot ulcer
Objective: The purpose of this article was to evaluate the clinical impact of diabetic foot ulcer (DFU) severity in patients with chronic limb-threatening ischemia (CLTI) who underwent distal open revascularization. Methods: This study included a single-center retrospective analysis of diabetic patients with CLTI who underwent distal revascularization between January 2012 and December 2019. The sample was divided into two groups according to DFU severity; group 1 was defined if observed Wound grade ≥ 2 and Infection grade ≥ 1 and group 2 was defined if observed Wound grade < 2 and Infection grade < 1, according to Wound, Ischemia, and foot Infection (WIfI) classification. The primary endpoint was achieving freedom from CLTI at 1 year. Secondary endpoints encompassed the recurrence of CLTI, limb salvage, amputation-free survival, overall survival, and primary patency over a 4-year follow-up period. Results: A total of 258 distal bypasses were performed in diabetic patients with CLTI. Among these, 95 patients had infected major foot lesions (group 1), while the remaining 163 limbs comprised group 2. Group 1 patients were slightly younger, with a median age of 72 years (IQR 14), compared to 74 years (IQR 14) in group 2 (p=0.045). Most of the patients achieved freedom from CLTI at 12 months (82%), with no significant differences between groups (HR 0.75, CI 0.53-1.04, p=0.084; aHR 0.77, CI 0.54-1.08, p=0.130). At 4 years of follow-up, recurrence rates of CLTI and limb salvage were no different between groups (HR 0.68, CI 0.34-1.35, p=0.266; aHR 0.71, CI 0.34-1.48, p=0.355 and HR 1.18, CI 0.63-2.24, p=0.591; aHR 1.81, CI 0.80-4.11, p=0.155, respectively). Survival-related end points were not different between groups, except when adjusted for baseline characteristics and graft type (survival: HR 1.50, CI 0.96-2.33, p=0.072; aHR 2.49, CI 1.54-4.05, p<0.001; amputation-free survival: HR 1.37, CI 0.97-1.92, p=0.071; aHR 2.03, CI 1.40-2.93, p<0.001). Conclusion: The present study emphasizes the value of distal revascularization in limb salvage of patients with diabetic foot, independently of the DFU severity. However, these results suggest a lower survival in patients with infected major foot lesions. Further studies are needed to assert these findings.
