Predictive Factors for Secondary Revasculation Procedures in Patients with Diabetic Foot Gangrene Undergoing Transtibial Amputation Following Revascularization

Purpose: Diabetic foot ulcers and gangrene are major complications of diabetes, often accompanied by peripheral vascular occlusion.Revascularization is performed to restore blood flow and reduce complications such as amputation surgery.Nevertheless, reocclusion, a frequently reported complication after revascularization, often necessitates further lower limb amputations to facilitate rehabilitation and ambulation.This study examined the factors influencing the performance of secondary revascularization procedures in patients with diabetic foot gangrene who even underwent transtibial amputation (TTA) following revascularization. Materials and Methods: A retrospective study was conducted on 36 patients with diabetic foot gangrene who underwent TTA after revascularization from March 2005 to March 2022.The factors influencing restenosis were classified into three categories: revascularization factors, preoperative factors, and intraoperative factors.The revascularization factors were categorized based on whether percutaneous transluminal angioplasty (PTA) or bypass surgery had been performed.Preoperative factors included the patient's age, gender, body mass index (BMI), hypertension, and other relevant factors.Intraoperative factors included surgery duration, blood loss, and transfusion.The study examined the factors influencing secondary revascularization in these three categories.Results: Among the 36 patients in the study, 27.8% (11 patients) underwent secondary revascularization procedures.There was no significant correlation between the performance of secondary revascularization and the type of revascularization procedure, whether PTA or bypass surgery (p>0.05).Similarly, no significant differences were observed in preoperative factors (including age, BMI, smoking status, HbA1c, and underlying diseases) and intraoperative factors (surgery duration, blood loss, and transfusion).On the other hand, regarding gender, all patients who underwent revascularization procedures were male, indicating a statistically significant result (p=0.039). Conclusion:This study suggests that while most clinical variables showed no association with reocclusion, the fact that all patients who underwent secondary revascularization procedures were male indicates that gender may be a significant predictive factor of revascularization.