Risk Factors for Major Lower Limb Amputation and Effect of Endovascular Revascularization in Patients with Diabetic Foot Wound.

Objective: Major lower extremity amputation (LEA) such as below-knee or above-knee amputations can result in more physical disabilities and poorer socioeconomic functions than minor LEAs in diabetic foot ulcer (DFU). Therefore, identification of risk factors for major LEA and investigation of effectiveness of endovascular revascularization are critical for prevention and better prognosis of DFU patients.

Methods: From January 2014 to December 2017, a total of 125 patients with DFU treated with any level of amputation were included in this study. Demographic, diabetes-related, DFU-related and -relevant laboratory information were investigated to predict major amputation. To identify risk factors for major amputation, logistic regression analysis was performed for each variable. The effectiveness of endovascular revascularization treatment was analyzed using Kaplan-Meier survival curves.

Results: Major amputation was performed for 22 of 125 patients. Multivariate logistic regression analysis indicated that DM duration, peripheral arterial occlusive disease (PAOD) previous amputation, abscess, Wagner grade, CRP and albumin were significant risk factors for major amputation in DFU patients. PAOD was the most important risk factor. Major amputation-free survival rate at 5 years was 97.4% in a non-PAOD group, 58.3% in a PAOD without revascularization group, and 88.0% in a PAOD with revascularization group, showing statistically significant differences among them.

Conclusion: The duration of DM, PAOD, previous amputation, abscess, Wagner grade, CRP and albumin were major risk factors for major LEA in DFU patients. The most valuable and critical finding was that revascularization in diabetic foot patients with PAOD significantly improved major amputation-free survival rates.