Diabetic Foot Infection: Preliminary Results of a Fast-Track Program with Early Endovascular Revascularization and Local Surgical Treatment

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• 作者：Nicola Troisi¹ ; ² ; ^{nicola.troisi@asf.toscana.it" class="auth_mail" title="E-mail the corresponding author} ; Leonardo Ercolini¹ ; ² ; Emiliano Chisci¹ ; ² ; Cristiana Baggiore² ; Tania Chechi² ; Francesco Manetti² ; Barbara Del Pin² ; Roberto Virgili² ; Giangiuseppe Alberti Lepri² ; Giancarlo Landini² ; Stefano Michelagnoli¹ ; ²
• 刊名：Annals of Vascular Surgery
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：30
• 期：Complete
• 页码：286-291
• 全文大小：637 K

文摘

To demonstrate that a fast-track program consisting in early endovascular revascularization and local surgical treatment saves tissue in patients with diabetic foot infection (DFI).

Methods

Between January and December 2014, 48 patients with DFI underwent early endovascular revascularization and local surgical treatment at our Diabetic Foot Center. In all cases, endovascular revascularization and local surgical treatment were performed within 1 week from the diagnosis of infection and during the same hospital stay. One-year outcomes were evaluated in terms of survival, primary patency, primary-assisted patency, secondary patency, absence of target lesion restenosis (TLR), and limb salvage.

Results

The patients were predominantly males (34 of 48, 70.8%) with a mean age of 72.4 years (range, 51–91). The target vessel was a tibial artery in 34 cases (70.8%). Surgical treatment consisted of debridement without bone resection in 27 cases (56.2%), toe and/or ray amputation in 15 cases (31.2%), Lisfranc amputation in 2 cases (4.2%), transmetatarsal amputation in 2 cases (4.2%). In the remaining 2 cases, a leg amputation was necessary with an overall 30-day major amputation rate of 4.2%. During the follow-up (mean duration 6.9 months, range 1–12) healing of the lesions was obtained in 30 cases (62.5%). Estimated 12-month survival, primary patency, primary-assisted patency, secondary patency, absence of TLR, and limb salvage rates were 83.5%, 53.4%, 65%, 65%, 60.7%, and 86.6%, respectively.

Conclusions

A fast-track program consisting in early endovascular revascularization and local surgical treatment contributes to our experience in limiting amputation levels in patients with DFI. A multidisciplinary approach and adoption of diabetic foot triage are essential to achieve these outcomes.