Peripheral arterial disease and neuroischemic ulcers in diabetic Charcot foot: a criminal conspiracy

NewsBot · Oct 19, 2018

Members do not see these Ads. Sign Up.
Peripheral arterial disease and neuroischemic ulcers in diabetic Charcot foot: a criminal conspiracy?
L Orioli et al
Endocrine Abstracts (2018) 57 018 | DOI: 10.1530/endoabs.57.018

Aims: The aims of our study were to compare 1) the prevalence of peripheral arterial disease (PAD) and neuroischemic foot ulcers (NFU) in diabetic patients with and without Charcot foot (CF), 2) the characteristics of PAD in these 2 groups, 3) the major outcomes of NFU including the one year limb salvage rate and one year survival rate in patients with and without CF.

Methods: We retrospectively reviewed the medical records of 172 diabetic patients hospitalized in our unit between 2010 and 2014 for diabetic foot problems, identified using the ICD-9-CM classification. The CF group included 56 patients and the diabetic foot (DF) group included 116 patients.

Main Results: Patients in the CF group were younger (61±10 years vs 65±11 years, P 0.01), had a higher BMI (31±7 kg vs 28±5 kg) and reported more often alcohol abuse than those in the DF group (46.4% vs 19.8%, P <0.001). The prevalence of PAD (66.1% vs 66.4%, P 0.97) and neuroischemic FU (69.5% vs 65.8%, P 0.73) were similar between the groups. PAD mostly affected the infrapopliteal arteries alone in the CF group (59.4% vs 26.7%, P 0.005) and both the infrapopliteal arteries and the femoral axis in the DF group (34.4% vs 65.3%, P 0.005). The need for revascularization was lower in the CF group (34.4% vs 78.7%, P <0.001). The one year limb salvage rate was similar between the groups (90.6% vs 89.3%, P 0.96) while the one year survival rate was lower in the CF group (93.8% vs 100.0%, P 0.03).

Conclusions: Clinicians should no longer consider CF as free from PAD and NFU despite their association is rarely reported. Interestingly, PAD in CF has specificities as it seems less severe and mostly involves the infrapopliteal arteries alone. The prognosis of NFU is poorer in patients with CF whose one year survival rate was lower. Thus, while NFU and PAD are excessively common in diabetic patients, their association with CF remains silent such as a criminal conspiracy, potentially harmful for both the limb and the patient.
Click to expand...

Admin2 · Oct 19, 2018

Related Threads:
Ten years of Charcot: what have we learned?
Physician's knowledge of Charcots neuroarthropathy
Charcot foot outcomes
Ischemic Charcot foot
A New Natural History of Charcot Foot
Charcot arthropathy and quality of life

NewsBot · Jun 11, 2021

Prevalence, Characteristics, and Prognosis of Peripheral Arterial Disease in Patients With Diabetic Charcot Foot
Laura Orioli et al
May 07, 2021

Charcot foot (CF) is a rare complication of diabetes associated with foot deformities and foot ulcers. Peripheral arterial disease (PAD) is a factor of poor prognosis in patients with diabetic foot ulcers (DFUs). However, PAD has infrequently been studied in CF. We aimed to determine the prevalence, the characteristics and the prognosis of PAD in a large group of patients with diabetic CF. We retrospectively compared 56 patients with diabetic CF to 116 patients with diabetic foot without CF. The prevalence of PAD in patients with CF was 66.1%. Compared to patients without CF, patients with CF had similar risks to have PAD (OR 0.98, 95%CI 0.50-1.94, p= .97) and neuro-ischemic DFUs (OR 1.19, 95%CI 0.57-2.49, p= .65), more risk to have lesions of distal arteries (OR 4.17, 95%CI 1.76-9.94, p= .001) and less risk to need revascularization (OR 0.14, 95%CI 0.06-0.36, p< .001). In patients with CF, PAD was strongly predicted by DFUs (OR 24.55, 95%CI 1.80-334.43, p= .016) and coronary artery disease (OR 17.11, 95%CI 1.75-167.43, p =.015). Survival rate and limb salvage rate in patients with CF were not worsened by PAD and by neuro-ischemic DFUs, respectively. In conclusion, we show that PAD should not be overlooked in patients with diabetic CF, especially in those having DFUs or coronary artery disease. PAD in patients with CF differed from that of patients without CF since it predominated in distal arteries and required less often revascularization.
Click to expand...

NewsBot · Jul 17, 2022

Complications of Charcot Reconstruction in Patients With Peripheral Arterial Disease
Nicole K. Cates, DPM, AACFAS et al
March 31, 2021

The primary aim was to determine the rate of complications in patients with peripheral arterial disease and diabetic Charcot neuroarthropathy who underwent osseous reconstruction. Complications included delayed healing, dehiscence, and major lower extremity amputation. A review of patients with Charcot neuroarthropathy requiring reconstruction secondary to ulceration or acute infection was performed. Descriptive analysis compared outcomes between those with and without peripheral arterial disease. Bivariate analysis and multivariate logistic regression were analyzed for delayed healing, dehiscence, and major amputation. In a cohort of 284 patients with diabetic Charcot neuroarthropathy who underwent osseous reconstruction, the rate of peripheral arterial disease was 20.8% (59/284). Bivariate analysis for delayed healing found hypertension (p = .0352), peripheral arterial disease (p = .0051), and smoking history (p = .0276) to be statistically significant factors. Delayed healing was 2.012 times more likely in the presence of peripheral arterial disease [OR 2.012 (95% CI 1.088-3.720)]. Bivariate analysis for major lower extremity amputation found renal disease (0.0003) (renal disease: ESRD and CKD) and peripheral arterial disease (0.0001) to be statistically significant factors. Major amputation was 4.414 times more likely in the presence of peripheral arterial disease [OR 4.414 (95% CI 2.087-9.334)]. Peripheral arterial disease was identified in 20.8% (59/284) of diabetic patients who underwent Charcot osseous reconstruction. Peripheral arterial disease increased the risk of delayed healing by 2.012 fold, and increased the risk of major lower extremity amputation by 4.414 fold. The rates of complications in patients with peripheral arterial disease were significantly higher than those without peripheral arterial disease who underwent osseous reconstruction.
Click to expand...

NewsBot The Admin that posts the news.

Admin2 Administrator Staff Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Hallucal thenar index: A new index to detect peripheral arterial disease

Lower limb pulse rise time as a marker of peripheral arterial disease

The PodPAD project: a podiatry-led integrated pathway for people with peripheral arterial disease

Can peripheral arterial disease be early screened for in a podiatric setting?

Optical tomography imaging of peripheral arterial disease

The accuracy of the physical examination for the detection of lower extremity peripheral arterial di

Peripheral Arterial Perfusion: Is it Adequate for Wound Healing?

Share This Page