Document Detail

Long-term outcome of successful percutaneous transluminal angioplasty of the fibular artery in diabetic foot syndrome and single-vessel calf perfusion depends on doppler wave pattern at the forefoot.
MedLine Citation:
PMID:  20186678     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In the diabetic foot syndrome (DFS) due to peripheral artery disease, the fibular artery is often the only vessel which can be revascularised. Because the fibular artery does not have a direct connection to the plantar arch, the clinical result of fibular artery PTA is dependent upon the extent of collateralization at the ankle. Therefore, successful PTA of the fibular artery with resulting biphasic doppler waves at the ankle can lead to either biphasic or monophasic post-occlusive doppler wave patterns at the forefoot. We evaluated prospectively the association of the forefoot doppler wave form on long-term clinical outcome in patients with DFS after successful PTA of the fibular artery.
PATIENTS AND METHODS: 44 patients with occluded calf vessels and DFS Wagner 2-4 underwent primary successful fibular artery PTA resulting in biphasic ankle doppler wave. According to doppler wave form at the forefoot, patients were divided into 1) a biphasic or 2) a monophasic group. Up to 45 months, we documented doppler wave forms, clinical course, restenosis, reinterventions, wound healing, major- and minor amputations.
RESULTS: PTA resulted in a biphasic doppler wave at the forefoot in 26 (59 %), in 18 (41 %) in a monophasic wave pattern. Biphasic forefoot doppler wave was strongly correlated with longer event-free survival (35 bi- vs. 5.5 months monophasic, p = 0.0018) and complete wound healing (69 % s bi- vs. 44 % vs. monophasic p = 0.0309). Major amputations: 2 / 26 (8 %) in the biphasic and in 3 / 18 (17 %) in the monophasic group. Second revascularisation procedures were more often necessary in the monophasic group (7 / 18 (39 % vs. 2 / 26 (8 %)).
CONCLUSION: After successful PTA of the fibular artery, monophasic doppler wave patterns at the forefoot denote insufficient collateralization and are associated with poor outcome. If successful fibular artery PTA results only in monophasic forefoot doppler, additional crural or pedal bypass should be strongly contemplated.
J Hering; B Angelkort; N Keck; J Wilde; B Amann
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  VASA. Zeitschrift für Gefässkrankheiten     Volume:  39     ISSN:  0301-1526     ISO Abbreviation:  VASA     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-26     Completed Date:  2010-04-30     Revised Date:  2012-10-19    
Medline Journal Info:
Nlm Unique ID:  0317051     Medline TA:  Vasa     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  67-75     Citation Subset:  IM    
Evangelisches Krankenhaus Unna, Germany.
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MeSH Terms
Aged, 80 and over
Amputation / statistics & numerical data
Angioplasty, Balloon / methods*
Diabetes Mellitus, Type 1 / complications
Diabetes Mellitus, Type 2 / complications
Diabetic Foot / surgery*
Disease-Free Survival
Fibula / blood supply*
Hemoglobin A, Glycosylated / analysis
Leg / blood supply*
Middle Aged
Peripheral Vascular Diseases / surgery*
Treatment Outcome
Wound Healing / physiology
Reg. No./Substance:
0/Hemoglobin A, Glycosylated

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