Digital archive of theses discussed at the University of Pisa


Thesis etd-11212019-104847

Thesis type
Tesi di specializzazione (5 anni)
Thesis title
Fast-track revascularization program for critical limb ischemia in Diabetic Foot patients: analysis of outcomes in a third-level center in North-West Tuscany
Course of study
relatore Prof. Caramella, Davide
correlatore Dott. Cicorelli, Antonio
  • interventional radiology
  • fast-track revascularization
  • diabetic ulcer
  • diabetic foot
  • revascularization
Graduation session start date
Release date
The global prevalence of diabetes mellitus has nearly doubled since 1980, rising from 4.7% to 8.5% in the adult population all over the world and its complications represent the third health costs generator. Peripheral arterial disease (PAD), whose severest pattern leads to critical limb ischemia (CLI), is one of the most important complications of diabetes for prevalence and severity, and still represents the most frequent cause of lower extremity amputation. In the last years, the endovascular strategy has become more frequent, representing now the first and less invasive approach for diabetic patients.
In 2018 at our Hospital, from a collaborative project between the Diabetic Foot Section of the Department of Medicine, the Interventional Radiology Unit and the Vascular Surgery Unit, a "Fast Track Revascularization" (FTR) protocol was created with the aim to match the need of a timely and effective endovascular revascularization with diabetic patients with CLI.
Aim of this study was to evaluate safety, efficacy and efficiency of the FTR strategy when compared with Standard track revascularization (STR) in our Hospital, which is the third level referral centre for north-west Tuscany.
All the patients with DFUs and CLI, who performed peripheral revascularization through endovascular approach from May to December 2018 were enrolled in the study.
In the period taken in consideration 146 patients underwent to a total of 204 procedures; among them 62 patients were randomised in the FTR group, 84 in the STR group. For the sake of this study only the first procedure was considered, average follow up was 8.09±3.15 months.
No statistically significant differences were observed at baseline in demographic features and regarding the localization of peripheral artery disease on pre-procedural DSA between the groups.
Regarding the efficacy of the revascularization procedures, no significant differences were observed in terms of Angiosome Targeted revascularization, healing rate, restenosis rate, major amputaion and death rates between the two groups.
In particular we observed 41/62 (66.1%) HR in FTR group and 42/84 (50%) in STR group (>0.05) and the MAR was 3/62 (4.8%), in FTR and 6/84 (7.1%) in STR (p>0.05).
Evaluating the safety of the two strategies we observed a comparable rate of Acute Adverse Events between the two groups.
On the efficiency side we observed a statistically significant shorter admission lenght [3.14±0.91 days vs. 14.77±9.175 days (p<0.01)] and Time to revascularization [15.3±8.7 days vs. 45.1±10.2 days (p<0.01)] in the FTR group respect to STR one.
Then we tried to identify predictors of healing with univariate regression analysis in our population and we pointed out an inverse significant correlation between WiFi score, dialysis and healing within follow-up.
When we analyse all those predictors with a multivariate according to Cox’s model, Wifi score showed the strongest significance followed by dialysis.
The experience of this new fast strategy it's a positive model of the collaboration between different physicians. A multidisciplinary approach that is the bases of FTR, can really improve the management of diabetic patients with CLI, as recommended in the recent International Working Group on Diabetic Foot (IWGDF) guidelines.