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Amputation-Free Survival in Patients With Diabetes Mellitus and Peripheral Arterial Disease With Heel Ulcer : Open Versus Endovascular Surgery

  • Talha Butt
  • Erika Lilja
  • Hedvig Örneholm
  • Jan Apelqvist
  • Anders Gottsäter
  • Magnus Eneroth
  • Stefan Acosta
Publishing year: 2019
Language: English
Pages: 118-125
Publication/Series: Vascular and Endovascular Surgery
Volume: 53
Issue: 2
Document type: Journal article
Publisher: SAGE Publications Inc.

Abstract english

BACKGROUND:: Heel ulcers in patients with diabetes mellitus (DM) and peripheral arterial disease (PAD) are hard to heal. The aim of the present study was to evaluate the difference in amputation-free survival (AFS) between open and endovascular revascularization in patients with DM, PAD, and heel ulcers.

METHODS:: Retrospective comparative study of results of open versus endovascular surgery in patients with DM, PAD, and heel ulcer presented at the multidisciplinary diabetes foot clinic between 1983 and 2013.

RESULTS:: Patients with heel ulcers were treated with endovascular intervention (n = 97) and open vascular surgery (n = 30). Kaplan-Meier analysis showed that the AFS was higher in patients undergoing open vascular surgery compared to the endovascular group ( P = .009). Multivariate analysis showed that open vascular surgery versus endovascular therapy (hazard ratio 2.1, 95% confidence interval 1.1-3.9; P = .025) was an independent factor associated with higher AFS. The proportion of patients undergoing endovascular therapy in the former (1983-2000) time period was 47% compared to 89% in the latter (2001-2013) time period ( P < .001).

CONCLUSION:: The AFS was higher after open than endovascular surgery among patients with DM and PAD with heel ulcer. These results suggest that open vascular surgery should be offered more often as opposed to current practice.


  • Surgery
  • Endocrinology and Diabetes


  • Vascular Diseases - Clinical Research
  • Orthopedics - Clinical and Molecular Osteoporosis Research
  • Genomics, Diabetes and Endocrinology
  • ISSN: 1938-9116
E-mail: jan [dot] apelqvist [at] med [dot] lu [dot] se


Genomics, Diabetes and Endocrinology

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