Abstract
Aim
Our study aimed to analyze 1) the prevalence of peripheral arterial disease (PAD) and infection in diabetic patients with and without Charcot foot (CF), 2) the characteristics of PAD in these 2 groups, 3) the prognosis of patients with CF and PAD and/or infection.
Method
We retrospectively reviewed the medical and radiological records of 172 hospitalized patients in our diabetic foot unit between 2010 and 2014. These patients were identified using the ICD-9-CM. The CF group and the diabetic foot (DF) group included 56 and 116 patients, respectively. All statistical analyses were performed using SPSS 25.0.01. A p <0.05 was considered as statistically significant.
Results
In the CF group, the prevalence of PAD and infection reached 66.1% and 67.9%, respectively. Diabetic foot ulcers (DFUs) were neuroischemic, infected or both in 69.5%, 80% and 57.7% of cases, respectively. No significant difference was found with the DF group. PAD in the CF group affected the infrapopliteal arteries alone more often (59.4% vs 26.7%, p 0.005) and neuroischemic DFUs needed less often revascularization (34.4% vs 78.7%, p <0.001). Endovascular revascularization was feasible in 77.8% of cases in the CF group, without significant difference with the DF group. Independent predictors of PAD in CF were DFUs (OR 24.5, CI 1.8–334.4, p 0.016) and coronary artery disease (OR 17.1, CI 1.7–167.4, p 0.016). Both patients' survival and limb salvage were not affected by PAD, neuroischemic DFUs and infected neuroischemic DFUs in the CF group.
Conclusions
In agreement with current literature, our study showed that infection is often associated with DFUs, both in DF and CF. However, our study demonstrated that beside infection, PAD is associated with CF more often than previously thought. As a consequence, DFUs in CF are most often neuroischemic. However, our study did not show worse outcomes in patients with CF and PAD or neuroischemic DFUs. This probably results from a less severe PAD in CF, a high rate of successful revascularization as well as a low rate of deaths and major amputations in our study. In conclusion, clinicians should no longer consider the CF as a purely neuropathic foot, especially in the presence of a DFU. Moreover, PAD in CF should be evaluated systematically before any surgical procedure as recommended in DF.
