The Effect of Atherosclerotic Load on Transmetatarsal Amputation Failure in Patients with Diabetic Foot

Mehmet Burak Çildağ; Tuna Şahin; Ender Ceylan; Şevki Öner Şavk

doi:10.4274/meandros.galenos.2022.68815

Araştırma Makalesi

The Effect of Atherosclerotic Load on Transmetatarsal Amputation Failure in Patients with Diabetic Foot

Yıl 2022, Cilt: 23 Sayı: 3, 400 - 405, 30.09.2022

Mehmet Burak Çildağ , Tuna Şahin , Ender Ceylan , Şevki Öner Şavk

Öz

Objective: The aim of this retrospective study was to investigate predictabilty of transmetatarsal amputation (TMA) failure in patients with diabetic foot with peripheral arterial disease.
Materials and Methods: Between January 2015 and November 2018, patients with diabetic foot, who had been followed up for 12 months after having TMA were evaluated. Atherosclerotic load was calculated from conventional angiographic images by using the modified Bollinger angiogram scoring method. Patients were classified as reamputation and non-reamputation groups after TMA at 12 months. Statistical difference analysis of atherosclerotic load was made between two groups.
Results: Twenty-seven diabetic foot patients whom have had TMA and angiographies before TMA were included in the study cohort. In the 12 month study period, 6 (22.2%) patients have had reamputation after TMA. The mean angiogram scores of reamputation group and non-reamputation group were 47.3 (±11.4) and 15.5 (±9.2), respectively. There was a statistically significant difference between the mean angiogram scoring of the two groups (p<0.001). Correlation was found between atherosclerotic load and TMA failure (r:-0,694, p<0.001). Receiveroperating characteristic curve analysis suggested that the optimum angiographic score cut-off value for reamputation at 12 month period was 29.5, with 100% sensitivity and 90.5% specificity.
Conclusion: Atherosclerotic load of lower limb arteries is associated with TMA failure. Atherosclerotic load that was calculated by using modified Bollinger angiographic score system can be used to predict TMA failure.

Anahtar Kelimeler

Transmetatarsal amputation, atherosclerotic load, diabetic foot

Kaynakça

1. O'Loughlin A, McIntosh C, Dinneen SF, O'Brien T. Review paper: basic concepts to novel therapies: a review of the diabetic foot. Int J Low Extrem Wounds 2010; 9: 90-102.
2. Reiber GE, Vileikyte L, Boyko EJ, del Aguila M, Smith DG, Lavery LA, et al. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care 1999; 22: 157-62.
3. Jones RN, Marshall WP. Does the proximity of an amputation, length of time between foot ulcer development and amputation, or glycemic control at the time of amputation affect the mortality rate of people with diabetes who undergo an amputation? Adv Skin Wound Care 2008; 21: 118-23.
4. Hosch J, Quiroga C, Bosma J, Peters EJ, Armstrong DG, Lavery LA. Outcomes of transmetatarsal amputations in patients with diabetes mellitus. J Foot Ankle Surg 1997; 36: 430-4.
5. O'Brien PJ, Cox MW, Shortell CK, Scarborough JE. Risk factors for early failure of surgical amputations: an analysis of 8,878 isolated lower extremity amputation procedures. J Am Coll Surg 2013; 216: 836-42.
6. Humphrey JA, Kanthasamy S, Coughlin P, Coll AP, Robinson AAH. Outcome of trans-metatarsal amputations in patients with diabetes mellitus. Foot (Edinb) 2019; 40: 22-6.
7. Bollinger A, Breddin K, Hess H, Heystraten FM, Kollath J, Konttila A, et al. Semiquantitative assessment of lower limb atherosclerosis from routine angiographic images. Atherosclerosis 1981; 38: 339-46.
8. Bradbury AW, Adam DJ, Bell J, Forbes JF, Fowkes FG, Gillespie I, et al. Multicentre randomised controlled trial of the clinical and cost-effectiveness of a bypass-surgery-first versus a balloon-angioplasty-first revascularisation strategy for severe limb ischaemia due to infrainguinal disease. The Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial. Health Technol Assess 2010; 14: 1-210.
9. Bradbury AW, Adam DJ, Bell J, Forbes JF, Fowkes FG, Gillespie I, et al. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: A description of the severity and extent of disease using the Bollinger angiogram scoring method and the TransAtlantic Inter-Society Consensus II classification. J Vasc Surg 2010; 51: 32-42.
10. Mckıttrıck LS, Mckıttrıck JB, Risley TS. Transmetatarsal amputation for infection or gangrene in patients with diabetes mellitus. Ann Surg 1949; 130: 826-42.
11. Blume P, Salonga C, Garbalosa J, Pierre-Paul D, Key J, Gahtan V, et al. Predictors for the healing of transmetatarsal amputations: retrospective study of 91 amputations. Vascular 2007; 15: 126-33.
12. Thomas SR, Perkins JM, Magee TR, Galland RB. Transmetatarsal amputation: an 8-year experience. Ann R Coll Surg Engl 2001; 83: 164-6.
13. Harris RC 3rd, Fang W. Transmetatarsal Amputation Outcomes When Utilized to Address Foot Gangrene and Infection: A Retrospective Chart Review. J Foot Ankle Surg 2021; 60: 269-75.
14. Thorud JC, Jupiter DC, Lorenzana J, Nguyen TT, Shibuya N. Reoperation and Reamputation After Transmetatarsal Amputation: A Systematic Review and Meta-Analysis. J Foot Ankle Surg 2016; 55: 1007-12.
15. Beaulieu RJ, Grimm JC, Lyu H, Abularrage CJ, Perler BA. Rates and predictors of readmission after minor lower extremity amputations. J Vasc Surg 2015; 62: 101-5.
16. Pollard J, Hamilton GA, Rush SM, Ford LA. Mortality and morbidity after transmetatarsal amputation: retrospective review of 101 cases. J Foot Ankle Surg 2006; 45: 91-7.
17. Pinzur M, Kaminsky M, Sage R, Cronin R, Osterman H. Amputations at the middle level of the foot. A retrospective and prospective review. J Bone Joint Surg Am 1986; 68: 1061-4.
18. Snyder DC, Salameh JR, Clericuzio CP. Retrospective review of forefoot amputations at a Veterans Affairs hospital and evaluation of post-amputation follow-up. Am J Surg 2006; 192: 51-4.
19. Mandolfino T, Canciglia A, Salibra M, Ricciardello D, Cuticone G. Functional outcomes of transmetatarsal amputation in the diabetic foot: timing of revascularization, wound healing and ambulatory status. Updates Surg 2016; 68: 401-5.
20. Shi E, Jex M, Patel S, Garg J. Outcomes of Wound Healing and Limb Loss After Transmetatarsal Amputation in the Presence of Peripheral Vascular Disease. J Foot Ankle Surg 2019; 58: 47-51.
21. Tan MNA, Lo ZJ, Lee SH, Teo RM, Tan WLG, Chandrasekar S. Review of Transmetatarsal Amputations in the Management of Peripheral Arterial Disease in an Asian Population. Ann Vasc Dis 2018; 11: 210-6.
22. van Overhagen H, Spiliopoulos S, Tsetis D. Below-the-knee interventions. Cardiovasc Intervent Radiol 2013; 36: 302-11.
23. Matsukura M, Hoshina K, Shigematsu K, Miyata T, Watanabe T. Paramalleolar Arterial Bollinger Score in the Era of Diabetes and End-Stage Renal Disease - Usefulness for Predicting Operative Outcome of Critical Limb Ischemia. Circ J 2016; 80: 235-42.
24. Toursarkissian B, Hagino RT, Khan K, Schoolfield J, Shireman PK, Harkless L. Healing of transmetatarsal amputation in the diabetic patient: is angiography predictive? Ann Vasc Surg 2005; 19: 769-73.

Yıl 2022, Cilt: 23 Sayı: 3, 400 - 405, 30.09.2022

Mehmet Burak Çildağ , Tuna Şahin , Ender Ceylan , Şevki Öner Şavk

Öz

Kaynakça

1. O'Loughlin A, McIntosh C, Dinneen SF, O'Brien T. Review paper: basic concepts to novel therapies: a review of the diabetic foot. Int J Low Extrem Wounds 2010; 9: 90-102.
2. Reiber GE, Vileikyte L, Boyko EJ, del Aguila M, Smith DG, Lavery LA, et al. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care 1999; 22: 157-62.
3. Jones RN, Marshall WP. Does the proximity of an amputation, length of time between foot ulcer development and amputation, or glycemic control at the time of amputation affect the mortality rate of people with diabetes who undergo an amputation? Adv Skin Wound Care 2008; 21: 118-23.
4. Hosch J, Quiroga C, Bosma J, Peters EJ, Armstrong DG, Lavery LA. Outcomes of transmetatarsal amputations in patients with diabetes mellitus. J Foot Ankle Surg 1997; 36: 430-4.
5. O'Brien PJ, Cox MW, Shortell CK, Scarborough JE. Risk factors for early failure of surgical amputations: an analysis of 8,878 isolated lower extremity amputation procedures. J Am Coll Surg 2013; 216: 836-42.
6. Humphrey JA, Kanthasamy S, Coughlin P, Coll AP, Robinson AAH. Outcome of trans-metatarsal amputations in patients with diabetes mellitus. Foot (Edinb) 2019; 40: 22-6.
7. Bollinger A, Breddin K, Hess H, Heystraten FM, Kollath J, Konttila A, et al. Semiquantitative assessment of lower limb atherosclerosis from routine angiographic images. Atherosclerosis 1981; 38: 339-46.
8. Bradbury AW, Adam DJ, Bell J, Forbes JF, Fowkes FG, Gillespie I, et al. Multicentre randomised controlled trial of the clinical and cost-effectiveness of a bypass-surgery-first versus a balloon-angioplasty-first revascularisation strategy for severe limb ischaemia due to infrainguinal disease. The Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial. Health Technol Assess 2010; 14: 1-210.
9. Bradbury AW, Adam DJ, Bell J, Forbes JF, Fowkes FG, Gillespie I, et al. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: A description of the severity and extent of disease using the Bollinger angiogram scoring method and the TransAtlantic Inter-Society Consensus II classification. J Vasc Surg 2010; 51: 32-42.
10. Mckıttrıck LS, Mckıttrıck JB, Risley TS. Transmetatarsal amputation for infection or gangrene in patients with diabetes mellitus. Ann Surg 1949; 130: 826-42.
11. Blume P, Salonga C, Garbalosa J, Pierre-Paul D, Key J, Gahtan V, et al. Predictors for the healing of transmetatarsal amputations: retrospective study of 91 amputations. Vascular 2007; 15: 126-33.
12. Thomas SR, Perkins JM, Magee TR, Galland RB. Transmetatarsal amputation: an 8-year experience. Ann R Coll Surg Engl 2001; 83: 164-6.
13. Harris RC 3rd, Fang W. Transmetatarsal Amputation Outcomes When Utilized to Address Foot Gangrene and Infection: A Retrospective Chart Review. J Foot Ankle Surg 2021; 60: 269-75.
14. Thorud JC, Jupiter DC, Lorenzana J, Nguyen TT, Shibuya N. Reoperation and Reamputation After Transmetatarsal Amputation: A Systematic Review and Meta-Analysis. J Foot Ankle Surg 2016; 55: 1007-12.
15. Beaulieu RJ, Grimm JC, Lyu H, Abularrage CJ, Perler BA. Rates and predictors of readmission after minor lower extremity amputations. J Vasc Surg 2015; 62: 101-5.
16. Pollard J, Hamilton GA, Rush SM, Ford LA. Mortality and morbidity after transmetatarsal amputation: retrospective review of 101 cases. J Foot Ankle Surg 2006; 45: 91-7.
17. Pinzur M, Kaminsky M, Sage R, Cronin R, Osterman H. Amputations at the middle level of the foot. A retrospective and prospective review. J Bone Joint Surg Am 1986; 68: 1061-4.
18. Snyder DC, Salameh JR, Clericuzio CP. Retrospective review of forefoot amputations at a Veterans Affairs hospital and evaluation of post-amputation follow-up. Am J Surg 2006; 192: 51-4.
19. Mandolfino T, Canciglia A, Salibra M, Ricciardello D, Cuticone G. Functional outcomes of transmetatarsal amputation in the diabetic foot: timing of revascularization, wound healing and ambulatory status. Updates Surg 2016; 68: 401-5.
20. Shi E, Jex M, Patel S, Garg J. Outcomes of Wound Healing and Limb Loss After Transmetatarsal Amputation in the Presence of Peripheral Vascular Disease. J Foot Ankle Surg 2019; 58: 47-51.
21. Tan MNA, Lo ZJ, Lee SH, Teo RM, Tan WLG, Chandrasekar S. Review of Transmetatarsal Amputations in the Management of Peripheral Arterial Disease in an Asian Population. Ann Vasc Dis 2018; 11: 210-6.
22. van Overhagen H, Spiliopoulos S, Tsetis D. Below-the-knee interventions. Cardiovasc Intervent Radiol 2013; 36: 302-11.
23. Matsukura M, Hoshina K, Shigematsu K, Miyata T, Watanabe T. Paramalleolar Arterial Bollinger Score in the Era of Diabetes and End-Stage Renal Disease - Usefulness for Predicting Operative Outcome of Critical Limb Ischemia. Circ J 2016; 80: 235-42.
24. Toursarkissian B, Hagino RT, Khan K, Schoolfield J, Shireman PK, Harkless L. Healing of transmetatarsal amputation in the diabetic patient: is angiography predictive? Ann Vasc Surg 2005; 19: 769-73.

Toplam 24 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	İngilizce
Konular	Radyoloji ve Organ Görüntüleme
Bölüm	Araştırma Makalesi
Yazarlar	Mehmet Burak Çildağ Tuna Şahin Ender Ceylan Şevki Öner Şavk
Yayımlanma Tarihi	30 Eylül 2022
Yayımlandığı Sayı	Yıl 2022 Cilt: 23 Sayı: 3

Kaynak Göster

EndNote	Çildağ MB, Şahin T, Ceylan E, Şavk ŞÖ (01 Eylül 2022) The Effect of Atherosclerotic Load on Transmetatarsal Amputation Failure in Patients with Diabetic Foot. Meandros Medical And Dental Journal 23 3 400–405.

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