Lei FR, Shen XF, Zhang C, Li XQ, Zhuang H, Sang HF. Clinical efficacy of endovascular revascularization combined with vacuum-assisted closure for the treatment of diabetic foot. World J Diabetes 2024; 15(7): 1499-1508 [PMID: 39099828 DOI: 10.4239/wjd.v15.i7.1499]
Corresponding Author of This Article
Hong-Fei Sang, Doctor, Chief Physician, Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Suzhou 215004, Jiangsu Province, China. sanghongfei@163.com
Research Domain of This Article
Peripheral Vascular Disease
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Feng-Rui Lei, Xiao-Fei Shen, Chuang Zhang, Xin-Qing Li, Hao Zhuang, Hong-Fei Sang, Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
Co-first authors: Feng-Rui Lei and Xiao-Fei Shen.
Author contributions: Lei FR, Shen XF and Sang HF designed the research and wrote the first manuscript; Lei FR, Shen XF, Zhang C, Li XQ, Zhuang H and Sang HF contributed to conceiving the research and analyzing data; Lei FR and Shen XF conducted the analysis and provided guidance for the research; all authors reviewed and approved the final manuscript. Lei FR and Shen XF contributed equally to this work and are co-first authors.
Institutional review board statement: This study was approved by the Ethic Committee of The Second Affiliated Hospital of Soochow University (Approval No. JD-HG-2024-003).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: There is no conflict of interest.
Data sharing statement: All data and materials are available from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Fei Sang, Doctor, Chief Physician, Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Suzhou 215004, Jiangsu Province, China. sanghongfei@163.com
Received: February 21, 2024 Revised: April 25, 2024 Accepted: May 21, 2024 Published online: July 15, 2024 Processing time: 137 Days and 22.9 Hours
Abstract
BACKGROUND
The diabetic foot is a common cause of disability and death, and comorbid foot infections usually lead to prolonged hospitalization, high healthcare costs, and a significant increase in amputation rates. And most diabetic foot trauma is complicated by lower extremity arteriopathy, which becomes an independent risk factor for major amputation in diabetic foot patients.
AIM
To establish the efficacy and safety of endovascular revascularization (ER) combined with vacuum-assisted closure (VAC) for the treatment of diabetic foot.
METHODS
Clinical data were collected from 40 patients with diabetic foot admitted to the Second Affiliated Hospital of Soochow University from April 2018 to April 2022. Diabetic foot lesions were graded according to Wagner’s classification, and blood flow to the lower extremity was evaluated using the ankle-brachial index test and computerized tomography angiography of the lower extremity arteries. Continuous subcutaneous insulin infusion pumps were used to achieve glycemic control. Lower limb revascularization was facilitated by percutaneous tran-sluminal balloon angioplasty (BA) or stenting. Wounds were cleaned by nibbling debridement. Wound granulation tissue growth was induced by VAC, and wound repair was performed by skin grafting or skin flap transplantation.
RESULTS
Of the 35 cases treated with lower limb revascularization, 34 were successful with a revascularization success rate of 97%. Of these, 6 cases underwent stenting after BA of the superficial femoral artery, and 1 received popliteal artery stent implantation. In the 25 cases treated with infrapopliteal artery revascularization, 39 arteries were reconstructed, 7 of which were treated by drug-coated BA and the remaining 32 with plain old BA. VAC was performed in 32 wounds. Twenty-four cases of skin grafting and 2 cases of skin flap transplantation were performed. Two patients underwent major amputations, whereas 17 had minor amputations, accounting for a success limb salvage rate of 95%.
CONCLUSION
ER in combination with VAC is a safe and effective treatment for diabetic foot that can significantly improve limb salvage rates. The use of VAC after ER simplifies and facilitates wound repair.
Core Tip: Diabetic foot trauma complicating lower-extremity arteriopathy is an independent risk factor for major amputation in patients with diabetic foot. Revascularization and wound repair are the two fundamental interventions in the treatment of diabetic foot. This study demonstrated that endovascular revascularization combined with vacuum-assisted closure is safe and effective treatment and can significantly improve limb salvage rates.
