Clinical Effect Of Endovascular Treatment Of Diabetic Foot Of Type 2 Plantar Arterial Arch By Angiosome Concept

Objective:To explore the clinical effect of endovascular treatment of diabetic foot(DF)of type2 plantar arterial arch by angiosome concept.Methods:A retrospective study was conducted on 57 diabetic foot patients(57 legs)with type2 plantar arterial arch who underwent endovascular treatment in the Department of Vascular Surgery,the General Hospital of TISCO and the Taiyuan Central Hospital from January 2019 to August 2021.According to whether the angiosome concept was followed,they were divided into direct revascularization(DR)group including 28 cases and indirect revascularization(IR)group including 29 cases.The clinical effects of all patients at 12 months after operation were evaluated,including ulcer healing rate,average ulcer healing time,large amputation rate,visual analogue score(VAS)and the Mos 36-item short form health survey(SF-36).About the continuous data,if it follows normal distribution,it chooses t-test;if not,it selects the rank sum test.Data was compared with Chi-square or Fisher’s exact test for the categorical data.Results:The ulcer healing rate of 57 DF patients with type 2 plantar arterial arch was 72.7%,the average healing time of ulcer was 6.22±2.55 months,and the large amputation rate was 7.02%.At 12 months after operation,compared to IR group,the ulcer healing rate was found to be higher in the DR group(χ~2=4.919,P=0.027),the average healing time of ulcer was shorter in the DR group(t=5.059,P<0.001),no considerable difference in the rate of large amputations in the DR group(P>0.05).Kaplan-Meier survival curve analysis showed that the ulcer healing time difference between the two groups was found to be of great statistical significance(χ~2=14.364,P<0.001).The median ulcer healing time was 5(3.57,6.43)months in DR group and 8(6.64,9.36)months in IR group.At 12months after operation,the VAS score was dramatically lower for the DR group than for the IR group(Z=-2.131,P=0.033).No further significant difference between the preoperative DR and IR groups in VAS score(P>0.05).The DR group scored much higher on the SF-36 than the IR group(Z=2.824,P=0.007)at 12 months after operation.No further significant difference between the preoperative DR and IR groups in SF-36score(P>0.05).In the DR group,there was no notable difference in ulcer healing rate,average ulcer healing time,large amputation rate,VAS and SF-36 score between the opening of multiple infrapopliteal arteries and the opening of a single infrapopliteal artery(P>0.05).Conclusion:1.Direct revascularization of type 2 arch diabetic foot can improve ulcer healing rate and shorten ulcer healing time.2.Direct revascularization of type 2 arch diabetic foot can reduce pain and improve the quality of life of patients.3.In the direct revascularization group,there was no significant improvement in ulcer healing rate,ulcer healing time and large amputation rate compared with single infrapopliteal artery.