Small Artery Disease in Persons with Diabetic Foot Ulcers: Incidence, Characteristics, and Outcomes

The study aimed to evaluate the incidence and impact of small artery disease (SAD) in persons with ischaemic diabetic foot ulcers (DFUs). The current study is a retrospective research including patients with ischaemic DFUs treated by lower limb revascularization and managed in a specialized diabetic foot service between January 2021 and September 2023. Based on final angiograms, subjects were divided in 2 groups, those with SAD and those without. SAD was defined by the absence or poverty of the plantar arch and the arteries originating from it including tarsal, metatarsal, and digital arteries, and the calcaneal branches of the plantar arteries. At 1 year of follow-up, the following outcomes were evaluated and compared between groups: healing, minor and major amputation, survival. Overall, 128 patients were included, 80 (62.5%) with SAD and 48 (37.5%) without. Patients presenting SAD were older (72.4 vs 66.1 yrs, p = .03), had higher rate of dialysis (30 vs 20.8%, p = .02), and ischaemic heart disease (80 vs 40%, p = .0002) when compared to patients without SAD. They reported also more cases of gangrene (80 vs 56.2%, p = .001) and lower TcPO2 values both at the assessment (16 vs 27 mmHg, p = .03) and after the revascularization procedure (34 vs 48 mmHg, P = .02). Subjects with SAD in comparison to those without reported lower rate of healing (57.1 vs 90.0%, p < .0001), higher rate of minor amputation (80 vs 45.4, p < .0001), major amputation (10 vs 4.1%, p = .02), and mortality (15 vs 0%, p = .03). In addition, SAD resulted an independent predictor of non-healing (in association with dialysis), and major amputation (in association with the revascularization failure). SAD is a frequent pattern of peripheral arterial disease in subjects with DFUs and independently impacts on healing and amputation.