Peripheral Vascular Disease Diagnostic Related Outcomes in Diabetic Charcot Reconstruction

Nicole K. Cates, Tammer Elmarsafi, Taylor J. Bunka, Elliot T. Walters, Cameron M. Akbari, Caitlin Zarick, Karen K. Evans, John S. Steinberg, Christopher E. Attinger, Paul J. Kim

Research output: Contribution to journalArticle

Abstract

Postreconstructive outcomes were compared in diabetic patients with Charcot neuroarthropathy (CN) who had peripheral arterial disease (PAD) diagnosed with angiography versus patients who were diagnosed clinically. A retrospective review was performed of patients with diabetic CN requiring reconstruction secondary to ulceration and/or acute infection. Of the 284 patients in the CN osseous reconstruction cohort, after accounting for exclusion criteria, 59 (20.8%) patients with PAD were included in the analyses. Forty (67.8%) of these 59 patients were diagnosed with PAD clinically and 19 (32.2%) were diagnosed with the use of angiography. Bivariate analysis was used to compare outcomes between those diagnosed with PAD via angiography versus those diagnosed clinically for the following postreconstruction outcomes: wound healing, delayed healing, surgical site infection, pin tract infection, osteomyelitis, dehiscence, transfer ulcer, new site of Charcot collapse, contralateral Charcot event, nonunion, major lower extremity amputation, and return to ambulation. Bivariate analysis found return to ambulation postreconstruction (p = .0054) to be the only statistically significant factor. There was a trend toward significance for major lower extremity amputation, with higher rates of amputation in the clinically diagnosed PAD arm. Return to ambulation indicates improved functional outcomes. The main goal of limb salvage should be focused on improving the patient's functional performance. With significantly faster rates of return to ambulation and a trend toward decreased rates of major amputation, angiography was found to be a better assessor of PAD than clinical evaluations.

Original languageEnglish (US)
Pages (from-to)1058-1063
Number of pages6
JournalJournal of Foot and Ankle Surgery
Volume58
Issue number6
DOIs
StatePublished - Nov 2019
Externally publishedYes

Fingerprint

Peripheral Vascular Diseases
Peripheral Arterial Disease
Amputation
Walking
Angiography
Lower Extremity
Surgical Wound Infection
Limb Salvage
Osteomyelitis
Infection
Wound Healing
Ulcer
Arm

Keywords

  • 3
  • angiography
  • Charcot neuroarthropathy
  • function
  • osseous reconstruction

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Peripheral Vascular Disease Diagnostic Related Outcomes in Diabetic Charcot Reconstruction. / Cates, Nicole K.; Elmarsafi, Tammer; Bunka, Taylor J.; Walters, Elliot T.; Akbari, Cameron M.; Zarick, Caitlin; Evans, Karen K.; Steinberg, John S.; Attinger, Christopher E.; Kim, Paul J.

In: Journal of Foot and Ankle Surgery, Vol. 58, No. 6, 11.2019, p. 1058-1063.

Research output: Contribution to journalArticle

Cates, NK, Elmarsafi, T, Bunka, TJ, Walters, ET, Akbari, CM, Zarick, C, Evans, KK, Steinberg, JS, Attinger, CE & Kim, PJ 2019, 'Peripheral Vascular Disease Diagnostic Related Outcomes in Diabetic Charcot Reconstruction', Journal of Foot and Ankle Surgery, vol. 58, no. 6, pp. 1058-1063. https://doi.org/10.1053/j.jfas.2019.06.002
Cates, Nicole K. ; Elmarsafi, Tammer ; Bunka, Taylor J. ; Walters, Elliot T. ; Akbari, Cameron M. ; Zarick, Caitlin ; Evans, Karen K. ; Steinberg, John S. ; Attinger, Christopher E. ; Kim, Paul J. / Peripheral Vascular Disease Diagnostic Related Outcomes in Diabetic Charcot Reconstruction. In: Journal of Foot and Ankle Surgery. 2019 ; Vol. 58, No. 6. pp. 1058-1063.
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AU - Zarick, Caitlin

AU - Evans, Karen K.

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AB - Postreconstructive outcomes were compared in diabetic patients with Charcot neuroarthropathy (CN) who had peripheral arterial disease (PAD) diagnosed with angiography versus patients who were diagnosed clinically. A retrospective review was performed of patients with diabetic CN requiring reconstruction secondary to ulceration and/or acute infection. Of the 284 patients in the CN osseous reconstruction cohort, after accounting for exclusion criteria, 59 (20.8%) patients with PAD were included in the analyses. Forty (67.8%) of these 59 patients were diagnosed with PAD clinically and 19 (32.2%) were diagnosed with the use of angiography. Bivariate analysis was used to compare outcomes between those diagnosed with PAD via angiography versus those diagnosed clinically for the following postreconstruction outcomes: wound healing, delayed healing, surgical site infection, pin tract infection, osteomyelitis, dehiscence, transfer ulcer, new site of Charcot collapse, contralateral Charcot event, nonunion, major lower extremity amputation, and return to ambulation. Bivariate analysis found return to ambulation postreconstruction (p = .0054) to be the only statistically significant factor. There was a trend toward significance for major lower extremity amputation, with higher rates of amputation in the clinically diagnosed PAD arm. Return to ambulation indicates improved functional outcomes. The main goal of limb salvage should be focused on improving the patient's functional performance. With significantly faster rates of return to ambulation and a trend toward decreased rates of major amputation, angiography was found to be a better assessor of PAD than clinical evaluations.

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