Efficacy of below-the-knee angioplasty for healing of therapy-refractory ischemic diabetic foot ulcers: A case-series study

Abstract

Background and Objectives: Diabetic patients are at high risk of therapy-refractory ischemic diabetic ulcers of the lower extremities. This study aimed to assess the efficacy of angioplasty for healing of therapy-refractory ischemic diabetic foot ulcers. Materials and Methods: This case series prospective study evaluated 40 hospitalized patients with therapy-refractory ischemic diabetic foot ulcers. Data regarding age, sex, hypertension, smoking status, end-stage renal disease (ESRD) and severity of ulcer before and after the intervention were collected using a researcher-designed questionnaire. Blood vessels with angiographic evidence of narrowing or arterial blockage underwent balloon angioplasty. Severity and healing of ulcers was scored using the Bates-Jensen criteria. Patients in whom, the severity of wound did not change after the surgical procedure were categorized as unhealed group while patients who experienced some degrees of healing were categorized as healed group. Data were analyzed using SPSS version 15 at P<0.05 level of significance. Results: The ulcers healed in 80 of patients following the intervention. A significant difference was noted in the mean score of wound severity following angioplasty in the two groups of healed and unhealed patients (P=0.001). The mean score of wound severity was compared before and after the intervention between healed and unhealed patients, males and females, subgroups with and without hypertension, subgroups with and without ESRD and smokers and non-smokers; the results showed that before the intervention, the mean score of wound severity was not significantly different in patients with/without the afore-mentioned risk factors (P>0.05). After the intervention, however, the mean score of wound severity in patients with ESRD was significantly higher than that in patients without ESRD (P=0.003). The results showed that healing did not depend on age, sex, presence/absence of hypertension or affliction with ESRD (P>0.05). Conclusion: Angioplasty seems to be an efficient modality for healing of therapy-resistant ischemic diabetic foot ulcers. Further studies on larger sample size are required to assess the efficacy of this modality in patients with certain risk factors. © 2019 Journal of Advanced Pharmacy Education & Research.