SLR - December 2017 - David M. Pagnanelli
Reference: Çildag MB, Ertugrul BM, Köseoglu ÖF, Çildag S, Armstrong DG. Angiographic Assessment of Atherosclerotic Load at the Lower Extremity in Patients with Diabetic Foot and Charcot Neuro-Arthropathy. J Chin Med Assoc. 2017 Oct 19; S1726-4901(17), 30273-3.
Scientific Literature Review
Reviewed By: David M. Pagnanelli, Jr., DPM
Residency Program: UPMC Pinnacle Health System, Harrisburg, PA
Podiatric Relevance: As podiatric surgeons and wound care specialists, we see a variety of lower-extremity wounds. Diabetic foot complications have a prevalence of 15 percent to 20 percent in all people living with diabetes. 7.5 percent of patients living with diabetes will develop Charcot neuro-arthropathy (CN). In patients living with diabetes and peripheral neuropathy, 29 percent will develop CN. Patients living with diabetes, foot complications and neuropathy have a greater prevalence of atherosclerotic PAD. This study uses the Bollinger angiogram scoring method to compare atherosclerotic load in the lower extremity in patients with diabetic foot wounds and CN to patients with diabetic foot wounds without CN. Examining the atherosclerotic load of diabetic CN patients may lead to alternative or collaborative care when treating their complex disease.
Methods: Seventy-eight patients living with diabetes in a retrospective study were classified into two groups; 30 neuroischemic wounds with CN and 48 without CN. All of these patients had lower-extremity angiography with antegrade approach. The Bollinger scoring method was used to determine atherosclerotic load at the level foot. Comparison of the two groups was then analyzed.
Results: Of the 78 patients who met the inclusion criteria, 59 (75.6 percent) were men and 19 (24.3 percent) were women with a mean age of 66.4 years (range 51–84). Renal insufficiency was the most common comorbidity at 33.8 percent. The mean duration of a diabetes diagnosis in these patients was 22.2 years (8–32). Of the patients with diabetic foot wounds and CN, the total Bollinger angiogram scoring was 18.1 (std+/-11.6) with a mean infrapopliteal angiogram scoring of 15.7 (std+/-10.4). Of the patients with diabetic foot wounds without CN, the total Bollinger angiogram scoring was 42.8 (std+/-12.7) with a mean infrapopliteal angiogram scoring of 37.7 (std+/-12.0). There was no statistically significant difference between patient age, gender, diabetic disease duration and comorbid disease of the two groups. There was a statistical significant difference between the mean total and infrapopliteal angiogram scoring (p < 0.01) of the two groups. Percutaneous transluminal angioplasty was successfully performed on 52 of the patients who had stenosis and/or occlusions; others were referred to surgery.
Conclusions: Patients living with diabetes, foot wounds and CN had significantly less atherosclerotic load than patients with diabetic foot wounds without CN. Limitations of the study are the related to the retrospective design and a relatively small number of patients due to the inclusion and exclusion criteria.