The Role of Early Revascularization and Biomarkers in the Management of Diabetic Foot Ulcers: A Single Center Experience
Ettore Dinoto,
Francesca Ferlito,
Manfredi Agostino La Marca,
Graziella Tortomasi,
Francesca Urso,
Salvatore Evola,
Giovanni Guercio,
Marco Marcianò,
David Pakeliani,
Guido Bajardi,
Felice Pecoraro
Affiliations
Ettore Dinoto
Vascular Surgery Unit, AOUP Policlinico “P. Giaccone”, 90127 Palermo, Italy
Francesca Ferlito
Vascular Surgery Unit, AOUP Policlinico “P. Giaccone”, 90127 Palermo, Italy
Manfredi Agostino La Marca
Vascular Surgery Unit, AOUP Policlinico “P. Giaccone”, 90127 Palermo, Italy
Graziella Tortomasi
Vascular Surgery Unit, AOUP Policlinico “P. Giaccone”, 90127 Palermo, Italy
Francesca Urso
Vascular Surgery Unit, AOUP Policlinico “P. Giaccone”, 90127 Palermo, Italy
Salvatore Evola
Unit of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) “G. D’Alessandro”, University Hospital Paolo Giaccone, University of Palermo, 90127 Palermo, Italy
Giovanni Guercio
Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy
Marco Marcianò
Department of General and Emergency Surgery, Paolo Giaccone University Hospital, 90127 Palermo, Italy
David Pakeliani
Vascular Surgery Unit, Ospedali Riuniti Villa Sofia-Cervello, 90100 Palermo, Italy
Guido Bajardi
Vascular Surgery Unit, AOUP Policlinico “P. Giaccone”, 90127 Palermo, Italy
Felice Pecoraro
Vascular Surgery Unit, AOUP Policlinico “P. Giaccone”, 90127 Palermo, Italy
Diabetic neuropathy and Peripheral Arterial Disease (PAD) are the main etiological factors in foot ulceration. Herein, we report our experience of diabetic foot ulceration (DFU) management, with an analysis of the relationship between the rate of lower extremity amputation, in persons with infected DFU, after revascularization procedures performed to prevent major amputation. This study highlights the role of different biomarkers, showing their usefulness and potentiality in diabetic foot ulcer management, especially for the early diagnosis and therapy effectiveness monitoring. A retrospective analysis, from September 2016 to January 2021, of diabetic patients presenting diabetic foot with DFU, was performed. All patients were treated with at least one vascular procedure (endovascular, open, hybrid procedures) targeting PAD lesions. Outcomes measured were perioperative mortality and morbidity. Freedom from occlusion, primary and secondary patency, and amputation rate were registered. A total of 267 patients, with a mean age of 72.5 years, were included in the study. The major amputation rate was 6.2%, minor amputation rate was 17%. In our experience, extreme revascularization to obtain direct flow reduced the rate of amputations, with an increase in ulcer healing.
