Correlation between vascular involvement and surgical outcomes in diabetic foot patients - A prospective study

Abstract

Background: Diabetes is a major contributing factor in up to 70% of lower limb amputations. More than 60% of diabetic foot ulcers (DFU) have insufficient blood circulation due to peripheral vascular disease (PVD). The most dreaded consequence of a foot ulcer is limb amputation, occurring 5–10 times more often in diabetics than in the general population.

Aims and Objectives: To understand vasculopathy associated with diabetic foot disease and its impact on surgical outcome, to find out the risk factors leading to ulcer formation and causing vasculopathy in diabetic patients.

Materials and Methods: The observational study was done from the middle of 2023 to the end of 2024 on patients attending the general surgery out-patient department and emergency of Calcutta National Medical College. Hundred patients were studied considering inclusion and exclusion criteria.

Results: Among 100 participants, 34% were female, 66% were male with majority belonging to 61–70 years age-group (40%), followed by 51–60 years age-group (27%); 65% had neuropathy, 34% had vasculopathy; 28% had cellulitis, 44% had ulcer, 25% had gangrene, 3% had ulcer with gangrene as the clinical presentation. The most common vasculopathy was femoropopliteal occlusion (16%), followed by diffuse atherosclerotic changes (14%). Among limb-amputee patients, hemoglobin A1c (10.31±1.81) is higher than non-amputee patients (8.16±1.65).

Conclusion: DFU is a common complication of prolonged diabetes. Both preexisting PVD and neuropathy strongly correlate with advanced Wagner’s grade and need for amputation. Prevention and education about foot care in both patients and physicians are of utmost importance.