Peripheral Vascular Disease Diagnostic Related Outcomes in Diabetic Charcot Reconstruction.

MedStar author(s):
Citation: Journal of Foot & Ankle Surgery. 58(6):1058-1063, 2019 Nov.PMID: 31679658Institution: MedStar Washington Hospital CenterDepartment: Surgery/Plastic Surgery | Surgery/Podiatric Surgery | Surgery/Vascular SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Angiography/mt [Methods] | *Arthropathy, Neurogenic/su [Surgery] | *Diabetic Neuropathies/su [Surgery] | *Lower Extremity/bs [Blood Supply] | *Orthopedic Procedures/mt [Methods] | *Peripheral Arterial Disease/di [Diagnosis] | *Reconstructive Surgical Procedures/mt [Methods] | Adult | Aged | Arthropathy, Neurogenic/co [Complications] | Diabetic Neuropathies/co [Complications] | Female | Follow-Up Studies | Humans | Lower Extremity/su [Surgery] | Male | Middle Aged | Peripheral Arterial Disease/su [Surgery] | Retrospective Studies | Treatment OutcomeYear: 2019Local holdings: Available online through MWHC library: 2003 - present, Available in print through MWHC library:1999-2007ISSN:
  • 1067-2516
Name of journal: The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle SurgeonsAbstract: 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. Copyright (c) 2019 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.All authors: Akbari CM, Attinger CE, Bunka TJ, Cates NK, Elmarsafi T, Evans KK, Kim PJ, Steinberg JS, Walters ET, Zarick COriginally published: Journal of Foot & Ankle Surgery. 58(6):1058-1063, 2019 Nov.Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2019-11-19
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 31679658 Available 31679658

Available online through MWHC library: 2003 - present, Available in print through MWHC library:1999-2007

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. Copyright (c) 2019 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

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