CARBON DIOXIDE ANGIOGRAPHY AND A CLINICAL SUITABILITY SCALE FOR ENDOVASCULAR INTERVENTIONS IN PATIENTS WITH THE NEUROISCHEMIC FORM OF DIABETIC FOOT SYNDROME AND CHRONIC KIDNEY DISEASE: A COMPARATIVE COHORT STUDY

The neuroischemic form of diabetic foot syndrome (DFS) in patients with chronic kidney disease (CKD) is one of the most severe clinical conditions with an unfavorable prognosis. In such patients, angiography using traditional iodine containing contrast agents is often limited due to the risk of developing contrast associated nephropathy. As a result, the number of revascularization procedures is reduced, and the frequency of amputations increases. The aim of this study is to evaluate the effectiveness and safety of a differentiated endovascular treatment strategy based on the use of carboxyangiography (CO₂A) and the clinical eligibility score for endovascular interven­tions (CES EVI) in patients with neuroischemic form of DFU and CKD. The study included 114 patients with neuroischemic form of DFU and CKD. In the control group, standard diagnostic and surgical treatment methods were used, including limited use of angiographic studies. In the main group, an individualized treatment strategy based on the CES-EVI and CO₂A scales was implemented. Depending on the stage of CKD, patients were divided into two groups: G1–G3a and G3b–G5. Clinical assessment included metabolic, laboratory, microbiological, and angiographic studies. The primary endpoints assessed were the feasibility of performing endovascular interventions, anatomical and functional preservation of the limb, renal safety, and six month mortality. The results showed that in the control group, the likelihood of performing revascularization was only 27.3%. In patients with CKD stages G3b–G5, the frequency of major amputations reached 52.4%, and after angiography, a deterioration in kidney function was observed in 23.8% of patients. In contrast, in the main group, thanks to stratifi­cation by CES EVI and the use of CO₂A, the likelihood of performing revascularization reached 100% in 71.2% of patients. The frequency of major amputations decreased by 2.5–3 times, and the frequency of impaired renal function after angiography decreased sevenfold. The anatomical limb preservation rate reached 100% in the G1–G3a group and 58.6% in the G3b–G5 group. The functional limb preservation rates were 100% and 72.4%, respectively. Six month mortality decreased by almost half compared to the control group. The combined use of carboxyangiography and the CES-EVI scale provides a kidney safe and individualized approach to treating patients with the neuroischemic form of DFS and CKD.