Álvaro-Afonso Francisco Javier, García-Álvarez Yolanda, García-Morales Esther Alicia, Flores-Escobar Sebastián, De Benito-Fernández Luis, Alfayate-García Jesús, Sánchez-Ríos Juan Pedro, Puras-Mallagray Enrique, Malo-Benages Esteban Javier, Ramírez-Ortega Marta, Redondo-López Sandra, Cecilia-Matilla Almudena, Lázaro-Martínez José Luis
Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
Diabetic Foot Unit, Angiology and Vascular Department, Hospital Universitario Fundación Alcorcón, 28922 Alcorcon, Spain.
Healthcare (Basel). 2024 Aug 20;12(16):1664. doi: 10.3390/healthcare12161664.
BACKGROUND/OBJECTIVES: To analyze the best noninvasive tests prognosis marker in patients with diabetic foot ulcer (DFU) who underwent endovascular revascularization based on clinical outcomes, such as healing rate, time to heal, and free amputation survival after at least a six-month follow-up.
A multicentric prospective observational study was performed with 28 participants with ischemic or neuroischemic DFU who came to the participant centers and underwent endovascular revascularization between January 2022 and March 2023. Toe systolic pressure (TP), ankle systolic pressure (AP), the ankle brachial pressure index (ABPI), the toe brachial pressure index (TBPI), transcutaneous pressure of oxygen (TcPO), and skin perfusion pressure (SPP) were evaluated using PeriFlux 6000 System, Perimed, Sweden, before (Visit 0) and four weeks after revascularization (Visit 1). The primary clinical outcome was an evaluation of the clinical evolution of noninvasive tests comparing Visit 0 and Visit 1, estimating the sensitivity for predicting wound healing of noninvasive tests at six months following initial recruitment.
After six months, 71.43% (n = 20) of DFU healed, four patients (14.3%) received major amputations, and one (3.5%) died. The two tests that best predicted wound healing after revascularization according to the ROC curve were TcPO and TP with sensitivities of 0.89 and 0.70 for the cut-off points of 24 mmHg and 46 mmHg, respectively.
TcPO and TP were the two tests that best predicted wound healing in patients who underwent endovascular revascularization. Clinicians should consider the importance of the evaluation of microcirculation in the healing prognosis of patients with diabetic foot ulcers.
背景/目的：根据临床结局，如愈合率、愈合时间和至少随访6个月后的非截肢生存率，分析接受血管内血运重建术的糖尿病足溃疡（DFU）患者的最佳无创检测预后标志物。
进行了一项多中心前瞻性观察性研究，28例缺血性或神经缺血性DFU患者到参与中心就诊，并于2022年1月至2023年3月接受了血管内血运重建术。使用瑞典Perimed公司的PeriFlux 6000系统在血运重建术前（访视0）和术后4周（访视1）评估趾收缩压（TP）、踝收缩压（AP）、踝肱压力指数（ABPI）、趾肱压力指数（TBPI）、经皮氧分压（TcPO）和皮肤灌注压（SPP）。主要临床结局是比较访视0和访视1时无创检测的临床演变，估计初次招募后6个月时无创检测预测伤口愈合的敏感性。
6个月后，71.43%（n = 20）的DFU愈合，4例患者（14.3%）接受了大截肢，1例（3.5%）死亡。根据ROC曲线，血运重建术后最能预测伤口愈合的两项检测是TcPO和TP，其截断点分别为24 mmHg和46 mmHg时，敏感性分别为0.89和0.70。
TcPO和TP是血管内血运重建术患者中最能预测伤口愈合的两项检测。临床医生应考虑评估微循环在糖尿病足溃疡患者愈合预后中的重要性。
