ANGIOGRAPHIC EVALUATION OF PERIPHERAL ARTERIAL OCCLUSIVE DISEASE AND ITS ROLE AS A PROGNOSTIC DETERMINANT FOR MAJOR AMPUTATION IN DIABETIC SUBJECTS WITH FOOT ULCERS

OBJECTIVE- To evaluate in diabetic patients with foot ulcers the angio graphic findings of peripheral occlusive arterial disease and their ro le as a prognostic determinant for major amputation. RESEARCH DESIGN E ND METHODS- From 1993 to 1995, 104 diabetic inpatients with foot ulcer s underwent arteriography on the ulcerated limb. Stenoses in the iliac trunk, the superficial femoral artery, the profunda femoral artery, t he popliteal artery, the anterior tibial artery, the posterior tibial artery, and the peroneal artery were scored on the basis of vessel lum en reduction: 0 if stenoses involved a reduction in the vessel lumen o f <50%, 1 if stenoses involved 50 to <75% reduction, 2 if stenoses inv olved 75 to <100% reduction, and 3 if total occlusion was present. The sum of the points assigned to each of these arteries was called the a ngiographic score. RESULTS- Stenoses causing a vessel lumen reduction greater than or equal to 50% were detected in 103 patients (99%). Sten oses were also detected in subjects with palpable foot pulses, ankle-b rachial indexes greater than or equal to 1, or transcutaneous oxygen t ension greater than or equal to 50 mmHg. The risk of major amputation was increased significantly when total occlusion was present in the po pliteal and infrapopliteal arteries (chi(2) for trend = 50.57, P <0.00 1). No major amputation was carried out in patients with angiographic scores <10; major amputation was carried out in all the patients with scores >14. Multivariate analysis indicated a high angiographic score as an independent risk factor for major amputation (odds ratio 2.32, P = 0.001, CI 1.40-3.84). CONCLUSIONS- Angiography permits an exact det ection of occlusive arterial disease in subjects with normal results f or noninvasive vascular procedures. A score that has a relevant progno stic value for major amputation can be obtained from the evaluation of the extent and diffusion of the stenoses.