Small Artery Disease as a Predictor of Wound Healing in Patients with Diabetic Foot After Revascularization.

Abstract

The aim of study was to confirm the hypothesis that advanced medial arterial calcification (MAC)/ small artery disease (SAD), much like the progression of peripheral arterial disease (PAD) stages can adversely impact the outcomes in DFU patients, even after successful endovascular procedures. In retrospective study, we enrolled 54 patients with DFUs who underwent percutaneous transluminal angioplasty (PTA). MAC was quantified using a three-level scoring system based on radiographs. Patients were categorized based on their MAC score into three groups. Study groups were compared in terms of primary DFU outcomes (healing, amputations) and secondary DFU outcomes (mortality, changes in transcutaneous oxygen pressure (TcPO2)) three and six months after PTA. The MAC/SAD score increased significantly with age (p = 0.014). The MAC/SAD score was't associated with the risk of amputation or the healing of DFUs up to three months after revascularization. However, a significant association was observed after six months (p = 0.043). The MAC/SAD score correlated significantly with severity of PAD, as classified by the Global Limb Anatomic Staging System (p = 0.042) and the Graziani system (p = 0.019). We found a negative correlation between the MAC/SAD score and absolute levels of TcPO2 after PTA. MAC/SAD score was significantly associated with long-term unhealed DFUs and the risk of lower limb amputations.