Endovascular Management in Patient with Ischemic Diabetic Foot Ulcer and Digital Ischemia in General Surgery Department Misurata Medical Center
Keywords:
Diabetic foot ulcer, Peripheral artery disease, ritical limb-threatening ischemia, Endovascular revascularization, Percutaneous transluminal angioplastyAbstract
Background: Peripheral arterial occlusive disease (PAOD) is a major cause of hospitalization, lower-limb amputation, and mortality worldwide. Patients with diabetes mellitus and peripheral artery disease (PAD) have significantly higher mortality rates than non-diabetic patients, with reported 5-year mortality exceeding 30%.
Objectives: To evaluate the outcomes of endovascular interventions in diabetic foot patients with femoropopliteal, infrapopliteal, and multilevel arterial occlusive disease.
Patients and Methods: A retrospective study was conducted on 20 patients treated at Misrata Medical Center between January and December 2025. All patients had diabetic foot ulcers and/or digital ischemia associated with femoropopliteal, infrapopliteal, or multilevel arterial occlusions. Procedures were performed in the General Surgery and Vascular Surgery Departments.
Results: The study included 17 males (85%) and 3 females (15%), with a mean age of 62.5 years. Limb salvage, defined as freedom from major amputation, was achieved in 90% of patients at 3 months. Clinical success, defined as relief of rest pain, ulcer healing improvement, and limb preservation according to Rutherford categories, was also achieved in 90% of cases. Two patients (10%) developed complications: one underwent thromboembolectomy for arterial thrombosis but ultimately required above-knee amputation, while the other underwent femoro-distal bypass surgery.
Conclusions: Percutaneous Transluminal Angioplasty (PTA) was successfully performed in 18 patients (90%), resulting in effective limb salvage and significant clinical improvement. Endovascular intervention appears to be a safe and effective limb-preserving treatment for diabetic patients with lower-limb arterial occlusive disease.
References
(1) Prompers L, Schaper N, Apelqvist J, et al. Prediction of outcome in individuals with diabetic foot ulcers: focus on differences between individuals with and without peripheral arterial disease. Diabetologia. 2008;51(5):747–755.
(2) Jeffcoate WJ, Chipchase SY, Ince P, Game FL. Assessing outcome of diabetic foot ulcer management using ulcer-related and person-related measures. Diabetes Care. 2006;29(8):1784–1787.
(3) Elgzyri T, Larsson J, Nyberg P, Thörne J, Eriksson KF, Apelqvist J. Early revascularization affects healing probability of ischemic foot ulcers in patients with diabetes. Eur J Vasc Endovasc Surg. 2014;48(4):440–446.
(4) Hinchliffe RJ, Brownrigg JR, Andros G, et al. Effectiveness of revascularization of the ulcerated foot in diabetes and peripheral arterial disease: systematic review. Diabetes Metab Res Rev. 2016;32(Suppl 1):136–144.
(5) Forsythe RO, Brownrigg JR, Hinchliffe RJ. Peripheral arterial disease and revascularization of the diabetic foot. Diabetes Obes Metab. 2015;17(5):435–444.
(6) Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367–2375.
(7) Faglia E, Mantero M, et al. Extensive use of peripheral angioplasty in ischemic diabetic foot ulcers: clinical results of 221 subjects. J Intern Med. 2002;252:225–232.
(8) Elgzyri T, Larsson J, Thörne J, Eriksson KF, Apelqvist J. Outcome of ischemic foot ulcers without invasive vascular intervention. Eur J Vasc Endovasc Surg. 2013;46(1):110–117.
(9) Lyundup AV, Balyasin MV, Maksimova NV, Kovina MV, Krasheninnikov ME. Diabetic foot ulcer — diagnosis and classification. Int Wound J. 2022.
(10) Santema TB, Poyck PP, Ubbink DT. Comparing Meggitt-Wagner and University of Texas classification systems: inter-observer agreement for diabetic foot ulcers. Int Wound J. 2016;13(6):1137–1141.
(11) Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Harkless LB, Boulton AJM. Comparison of Wagner and University of Texas wound classifications for diabetic foot ulcers. Diabetes Care. 2001;24(1):84–88.
(12) Schaper NC, Van Netten JJ, Apelqvist J, et al. IWGDF/Global Vascular Guidelines on diabetic foot and CLTI management. J Vasc Surg. 2019;69(6S):3S–125S.e40.
(13) Saxon RR, Tegtmeyer CJ. Subintimal angioplasty for infrainguinal arterial occlusive disease: outcomes and limb salvage. J Endovasc Ther. 1998;5(1):84–92.
(14) Faglia E, Mantero M, et al. Extensive infrainguinal angioplasties for diabetic patients — clinical results. Indian J Radiol Imaging. 2008;18:156–161.
(15) Saab MH, Smith DC, Aka PK, Brownlee RW, Killeen JD. Percutaneous transluminal angioplasty of tibial arteries for limb salvage. Cardiovasc Intervent Radiol. 1992;15:211–216.
(16) Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(Suppl S):S5–S67.
(17) Schaper NC. Diabetic foot ulcer classification systems for research purposes: progress report. Diabetes Metab Res Rev. 2004;20(Suppl 1):S90–S95.
(18) Mills JL Sr, Conte MS, Armstrong DG, et al. Society for Vascular Surgery lower extremity threatened limb classification (WIfI). J Vasc Surg. 2014;59(1):220–234.e2.
(19) Fiedrichs S, et al. Effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral arterial disease: systematic review update. Diabetes Metab Res Rev. 2012;28(4):376 (erratum).
(20) Altoijry A, Khoo PK. Efficacy of revascularization vs. conservative treatment in diabetic foot ulcers with PAD — cohort assessment. Austin Surg. 2020;8(2):1280.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Mahmud Sunusi Amer، Taher Alkisa، Wael Fathi Emmaima، Hassan Omar Badi، Osama Aldergash، Wesam Elsaghayer
This work is licensed under a Creative Commons Attribution 4.0 International License.
