A recent study published in the European Journal of Vascular and Endovascular Surgery shows that without revascularization, a significant number of patients with severe peripheral arterial disease will die before their diabetic foot ulcers heal.1
The study focused on 602 patients with ischemic diabetic foot ulcers who had systolic toe pressures of <45 mmHg or ankle pressures of <80 mmHg, none of whom had received revascularization. Of those patients, researchers noted that 50 percent healed either primarily or with a minor amputation, while 17 percent of the remaining patients healed after a major amputation. One-third of the patients died unhealed.
As the authors note, the factors strongly related to outcome were comorbidity, the severity of peripheral arterial disease and the extent of tissue destruction. The study concludes that there is a need for a classification system that considers these factors when physicians are making decisions for vascular intervention.
I do very much believe we need more clarity on how we assess outflow. Under the leadership of my “Flowmigo,” Joe Mills, MD, we have made efforts toward this with what we now call “WIFI,” or “Wound,” “Ischemia” and “Foot Infection.” Each of these three can be graded as none, mild, moderate or severe. Physicians can use this classification to direct therapy and predict the outcome with what we believe will be a higher fidelity than past efforts.
1. Elgzyri T, Larsson J, Thorne J, Eriksson KF, Apelqvist J. Outcome of ischemic foot ulcer in diabetic patients who had no invasive vascular intervention. Eur J Vasc Endovasc Surg. 2013;46(1):110-7.
This blog has been adapted with permission from a blog that previously appeared at http://diabeticfootonline.blogspot.com/2013/05/one-third-of-patients-see...  .