Determining the Best Noninvasive Test for Peripheral Arterial Disease Diagnosis to Predict Diabetic Foot Ulcer Healing in Patients Following Endovascular Revascularization

Abstract

Download PDFsettingsOrder Article Reprints Open AccessArticle Determining the Best Noninvasive Test for Peripheral Arterial Disease Diagnosis to Predict Diabetic Foot Ulcer Healing in Patients Following Endovascular Revascularization by Francisco Javier Álvaro-Afonso 1ORCID,Yolanda García-Álvarez 1,*ORCID,Esther Alicia García-Morales 1ORCID,Sebastián Flores-Escobar 1ORCID,Luis De Benito-Fernández 2ORCID,Jesús Alfayate-García 2,Juan Pedro Sánchez-Ríos 2ORCID,Enrique Puras-Mallagray 3,4ORCID,Esteban Javier Malo-Benages 3ORCID,Marta Ramírez-Ortega 4ORCID,Sandra Redondo-López 5ORCID,Almudena Cecilia-Matilla 6ORCID andJosé Luis Lázaro-Martínez 1ORCID 1 Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain 2 Diabetic Foot Unit, Angiology and Vascular Department, Hospital Universitario Fundación Alcorcón, 28922 Alcorcon, Spain 3 Angiology, Vascular & Endovascular Department, Hospital Universitario Quirónsalud Madrid, 28223 Pozuelo de Alarcon, Spain 4 Angiology, Vascular & Endovascular Department, Hospital Universitario La Luz, Grupo Quironsalud, 28003 Madrid, Spain 5 Vascular Surgery Service, Ruber International Hospital Madrid, c/Masó 38, 28034 Madrid, Spain 6 Diabetic Foot Unit, Vascular Surgery Service, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) Crta, Colmenar Viejo Km 9100, 28034 Madrid, Spain * Author to whom correspondence should be addressed. Healthcare 2024, 12(16), 1664; https://doi.org/10.3390/healthcare12161664 Submission received: 22 July 2024 / Revised: 13 August 2024 / Accepted: 15 August 2024 / Published: 20 August 2024 (This article belongs to the Special Issue Research on Podiatric Medicine and Healthcare) Downloadkeyboard_arrow_down Browse Figures Versions Notes

Abstract Background/Objectives: To analyze the best noninvasive tests prognosis marker in patients with diabetic foot ulcer (DFU) who underwent endovascular revascularization based on clinical outcomes, such as healing rate, time to heal, and free amputation survival after at least a six-month follow-up. Methods: A multicentric prospective observational study was performed with 28 participants with ischemic or neuroischemic DFU who came to the participant centers and underwent endovascular revascularization between January 2022 and March 2023. Toe systolic pressure (TP), ankle systolic pressure (AP), the ankle brachial pressure index (ABPI), the toe brachial pressure index (TBPI), transcutaneous pressure of oxygen (TcPO2), and skin perfusion pressure (SPP) were evaluated using PeriFlux 6000 System, Perimed, Sweden, before (Visit 0) and four weeks after revascularization (Visit 1). The primary clinical outcome was an evaluation of the clinical evolution of noninvasive tests comparing Visit 0 and Visit 1, estimating the sensitivity for predicting wound healing of noninvasive tests at six months following initial recruitment. Results: After six months, 71.43% (n = 20) of DFU healed, four patients (14.3%) received major amputations, and one (3.5%) died. The two tests that best predicted wound healing after revascularization according to the ROC curve were TcPO2 and TP with sensitivities of 0.89 and 0.70 for the cut-off points of 24 mmHg and 46 mmHg, respectively. Conclusions: TcPO2 and TP were the two tests that best predicted wound healing in patients who underwent endovascular revascularization. Clinicians should consider the importance of the evaluation of microcirculation in the healing prognosis of patients with diabetic foot ulcers.