Willems Siem A, Broekman Sverre J, Smeets Mark J R, Brouwers Jeroen J W M, Statius van Eps Randolph G
Department of Vascular Surgery, Haga Teaching Hospital, The Hague, The Netherlands; Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Department of Vascular Surgery, Haga Teaching Hospital, The Hague, The Netherlands.
Ann Vasc Surg. 2025 Mar;112:306-314. doi: 10.1016/j.avsg.2024.12.051. Epub 2024 Dec 28.
Diabetic foot ulcers (DFUs) are one of the most serious chronic diabetes-related complications. Since medial arterial calcification (MAC) can be present in patients with a DFU, toe pressure (TP) measurements are advised to grade potential ischemia. However, the value of TP to predict clinical outcomes in this group of patients is poorly understood. Therefore, the primary aim of this study was to investigate the relationship between TP values and ulcer healing in patients with DFU and concomitant MAC.
A single-center retrospective cohort study was conducted. Patients were included if they were 18 years or older, presented with a DFU, had a TP measurement and concomitant MAC in the same limb. MAC was defined as an ankle-brachial index (ABI) above 1.30, or incompressible arteries during ABI measurement. Multistate models were fitted to analyze the outcomes of interest (ulcer healing, revascularization, amputation, and mortality).
In total, 148 patients were included. During the 180 days follow-up, the cumulative incidence of a healed ulcer was 34% (95% confidence interval [CI]: 27-42%), whereas 32% (95% CI: 26-41%) of patients had a persisting open wound. An approximately positive linear correlation was observed between TP values and the probability of ulcer healing, regardless of whether patients had undergone a revascularization procedure. However, the absolute healing rate was low, and no clear distinction could be made for intermediate TP values (between 30 and 80 mm Hg).
Lower TP values are correlated with nonhealing of a DFU in patients with MAC, but clear absolute differences in healing are only seen between very low (below 30 mm Hg) and high (above 80 mm Hg) measurements. For intermediate TP values, the predictive strength of ulcer healing is weak. This should be of particular importance when grading ischemia in this subgroup of patients in wound classification systems.
糖尿病足溃疡（DFU）是最严重的慢性糖尿病相关并发症之一。由于糖尿病足溃疡患者可能存在中动脉钙化（MAC），因此建议测量趾压（TP）以评估潜在缺血程度。然而，对于这组患者中TP预测临床结局的价值，人们了解甚少。因此，本研究的主要目的是探讨糖尿病足溃疡合并中动脉钙化患者的趾压值与溃疡愈合之间的关系。
进行了一项单中心回顾性队列研究。纳入年龄在18岁及以上、患有糖尿病足溃疡、在同一肢体进行了趾压测量且伴有中动脉钙化的患者。中动脉钙化定义为踝肱指数（ABI）高于1.30，或在ABI测量期间动脉不可压缩。采用多状态模型分析感兴趣的结局（溃疡愈合、血运重建、截肢和死亡率）。
共纳入148例患者。在180天的随访期间，溃疡愈合的累积发生率为34%（95%置信区间[CI]：27 - 42%），而32%（95%CI：26 - 41%）的患者伤口持续未愈合。无论患者是否接受了血运重建手术，均观察到趾压值与溃疡愈合概率之间存在近似正线性相关。然而，绝对愈合率较低，对于中等趾压值（30至80毫米汞柱之间）无法做出明确区分。
较低的趾压值与中动脉钙化患者糖尿病足溃疡不愈合相关，但仅在极低（低于30毫米汞柱）和极高（高于80毫米汞柱）测量值之间观察到愈合方面明显的绝对差异。对于中等趾压值，溃疡愈合的预测强度较弱。在伤口分类系统中对该亚组患者的缺血程度进行分级时，这一点应尤为重要。
