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Risk Factors for Major Lower Limb Amputation and Effect of Endovascular Revascularization in Patients with Diabetic Foot Wound

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Abstract

Objective

Major lower extremity amputation (LEA) such as below-knee or above-knee amputations can result in more physical disabilities and poorer socioeconomic functions than minor LEAs in diabetic foot ulcer (DFU). Therefore, identification of risk factors for major LEA and investigation of effectiveness of endovascular revascularization are critical for prevention and better prognosis of DFU patients.

Methods

From January 2014 to December 2017, a total of 125 patients with DFU treated with any level of amputation were included in this study. Demographic, diabetes-related, DFU-related and -relevant laboratory information were investigated to predict major amputation. To identify risk factors for major amputation, logistic regression analysis was performed for each variable. The effectiveness of endovascular revascularization treatment was analyzed using Kaplan–Meier survival curves.

Results

Major amputation was performed for 22 of 125 patients. Multivariate logistic regression analysis indicated that DM duration, peripheral arterial occlusive disease (PAOD) previous amputation, abscess, Wagner grade, CRP and albumin were significant risk factors for major amputation in DFU patients. PAOD was the most important risk factor. Major amputation-free survival rate at 5 years was 97.4% in a non-PAOD group, 58.3% in a PAOD without revascularization group, and 88.0% in a PAOD with revascularization group, showing statistically significant differences among them.

Conclusion

The duration of DM, PAOD, previous amputation, abscess, Wagner grade, CRP and albumin were major risk factors for major LEA in DFU patients. The most valuable and critical finding was that revascularization in diabetic foot patients with PAOD significantly improved major amputation-free survival rates.

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Data availability

All the data generated or analyzed during this study are included in the published article.

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Funding

This work was supported by a research grant from the Jeju National University Hospital in 2022.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Jeju National University Hospital, 15 Aran 13-gil, Jeju, 63241, Korea

    Hyunseong Kang, Sungwook Choi, Yong-Geun Park & Chaemoon Lim

  2. Division of Cardiology, Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea

    JoonHyouk Choi

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  1. Hyunseong Kang
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  2. Sungwook Choi
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  3. Yong-Geun Park
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  4. JoonHyouk Choi
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  5. Chaemoon Lim
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Contributions

Conception and design: HK and CL. Analysis and interpretation: HK and SC. Data collection: CL, YP and JC. Writing the article: CL. Critical revision of the article: HK, SC, YP and JC. Final approval of the article: HK, SC and CL. Obtained funding: HK. Overall responsibility: CL.

Corresponding author

Correspondence to Chaemoon Lim.

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Conflict of interest

No potential conflict of interest relevant to this article was reported.

Ethical Approval

This study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board (Ethics Committee) of Jeju National University Hospital (IRB approval No.: 2023-06-01).

Informed Consent

The patient’s informed consent was waived by the Institutional Review Board due to the retrospective nature of the study.

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Kang, H., Choi, S., Park, YG. et al. Risk Factors for Major Lower Limb Amputation and Effect of Endovascular Revascularization in Patients with Diabetic Foot Wound. JOIO 58, 379–386 (2024). https://doi.org/10.1007/s43465-024-01100-y

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  • DOI: https://doi.org/10.1007/s43465-024-01100-y

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