{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T04:15:40Z","timestamp":1790914540499,"version":"4.1.0"},"reference-count":23,"publisher":"American Diabetes Association","issue":"5","license":[{"start":{"date-parts":[[2021,8,28]],"date-time":"2021-08-28T00:00:00Z","timestamp":1630108800000},"content-version":"vor","delay-in-days":4196,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2010,5,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>We describe the long-term outcomes of 510 diabetic patients with critical limb ischemia (CLI) and an active foot ulcer or gangrene, seen at the University Hospital of Rome Tor Vergata, a tertiary care clinic.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>These patients were seen between November 2002 and November 2007 (mean follow-up 20 \u00b1 13 months [range 1\u201366 months]). The Texas Wound Classification was used to grade these wounds that were either class C (ischemia) and D (ischemia+infection) and grade 2\u20133 (deep\u2013very deep). This comprehensive treatment protocol includes rapid and extensive initial debridement, aggressive use of peripheral percutaneous angioplasty, empirical intravenous antibiotic therapy, and strict follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>The protocol was totally applied (with percutaneous angioplasty [PA+]) in 456 (89.4%) patients and partially (without percutaneous angioplasty [PA\u2212]) in 54 (10.6%) patients. Outcomes for the whole group and PA+ and PA\u2212 patients are, respectively: healing, n = 310 (60.8%), n = 284 (62.3%), and n = 26 (48.1%); major amputation, n = 80 (15.7%), n = 67 (14.7%), and n = 13 (24.1%); death, n = 83 (16.25%), n = 68 (14.9%), and n = 15 (27.8%); and nonhealing, n = 37 (7.25%), n = 37 (8.1%), and n = 0 (0%) (\u03c72 &amp;lt;0.0009). Predicting variables at multivariate analysis were the following: for healing, ulcer dimension, infection, and ischemic heart disease; and for major amputation, ulcer dimension, number of minor amputations, and age. Additional predicting variables for PA+ patients were the following: for healing, transcutaneous oxygen tension [\u0394TcPo2]; and for major amputation, basal TcPo2, basal A1C, \u0394TcPo2, and percutaneous angioplasty technical failure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Early diagnosis of CLI, aggressive treatment of infection, and extensive use of percutaneous angioplasty in ischemic affected ulcers offers improved outcome for many previously at-risk limbs. Ulcer size &amp;gt;5 cm2 indicates a reduced chance of healing and increased risk of major amputation. It was thought that all ulcers warrant aggressive treatment including percutaneous angioplasty and that treatment should be considered even for small ischemic ulcers.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc09-0831","type":"journal-article","created":{"date-parts":[[2010,3,4]],"date-time":"2010-03-04T02:55:33Z","timestamp":1267671333000},"page":"977-982","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":113,"title":["Long-Term Outcomes of Diabetic Patients With Critical Limb Ischemia Followed in a Tertiary Referral Diabetic Foot Clinic"],"prefix":"10.2337","volume":"33","author":[{"given":"Luigi","family":"Uccioli","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Tor Vergata, Rome, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Gandini","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Rome, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Giurato","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Tor Vergata, Rome, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastiano","family":"Fabiano","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Rome, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Pampana","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Rome, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenza","family":"Spallone","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Tor Vergata, Rome, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Vainieri","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Tor Vergata, Rome, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Simonetti","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Tor Vergata, Rome, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2010,3,3]]},"reference":[{"key":"2022031218200128400_B1","doi-asserted-by":"crossref","first-page":"97","DOI":"10.7326\/0003-4819-117-2-97","article-title":"Risk factors for amputation in patients with diabetes mellitus. A case-control study","volume":"117","author":"Reiber","year":"1992","journal-title":"Ann Intern Med"},{"key":"2022031218200128400_B2","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1080\/00015458.2004.11679637","article-title":"The multidisciplinary approach to limb salvage","volume":"104","author":"Sumpio","year":"2004","journal-title":"Acta Chir Belg"},{"key":"2022031218200128400_B3","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1016\/0741-5214(87)90303-X","article-title":"The clinical course of diabetics who require emergent foot surgery because of infection or ischemia","volume":"6","author":"Taylor","year":"1987","journal-title":"J Vasc Surg"},{"key":"2022031218200128400_B4","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1007\/s001250051459","article-title":"Decreasing incidence of major amputations in people with diabetes","volume":"43","author":"Holstein","year":"2000","journal-title":"Diabetologia"},{"key":"2022031218200128400_B5","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1067\/mva.2003.125","article-title":"A decade of experience with dorsalis pedis artery bypass: analysis of outcome in more than 1000 cases","volume":"37","author":"Pomposelli","year":"2003","journal-title":"J Vasc Surg"},{"key":"2022031218200128400_B6","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1097\/SLA.0b013e31814699a2","article-title":"Shifting paradigms in the treatment of lower extremity vascular disease. A report of 1000 percutaneous interventions","volume":"246","author":"DeRubertis","year":"2007","journal-title":"Ann Surg"},{"key":"2022031218200128400_B7","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1007\/s00270-008-9331-7","article-title":"Subintimal angioplasty for peripheral arterial occlusive disease: a systematic review","volume":"31","author":"Met","year":"2008","journal-title":"Cardiovasc Intervent Radiol"},{"key":"2022031218200128400_B8","first-page":"1925","article-title":"Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL): multicentre, randomised controlled trial","volume":"3","author":"Adam","year":"2005","journal-title":"Lancet"},{"key":"2022031218200128400_B9","doi-asserted-by":"crossref","first-page":"S351","DOI":"10.1097\/01.RVI.0000094603.61428.1c","article-title":"The TransAtlantic Inter-Society Consensus (TASC) on the management of peripheral arterial disease","volume":"14","author":"Sacks","year":"2003","journal-title":"J Vasc Interv Radiol"},{"key":"2022031218200128400_B10","doi-asserted-by":"crossref","first-page":"311","DOI":"10.7547\/87507315-86-7-311","article-title":"Treatment-based classification system for assessment and care of diabetic feet","volume":"86","author":"Armstrong","year":"1996","journal-title":"J Am Podiatr Med Assoc"},{"key":"2022031218200128400_B11","doi-asserted-by":"crossref","first-page":"855","DOI":"10.2337\/diacare.21.5.855","article-title":"Validation of a diabetic wound classification system. The contribution of depth, infection, and ischemia to risk of amputation","volume":"21","author":"Armstrong","year":"1998","journal-title":"Diabetes Care"},{"key":"2022031218200128400_B12","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1111\/j.1464-5491.2005.01446.x","article-title":"Transcutaneous oxygen tension monitoring after successful revascularization in diabetic patients with ischaemic foot ulcers","volume":"22","author":"Caselli","year":"2005","journal-title":"Diabet Med"},{"key":"2022031218200128400_B13","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.2337\/diab.40.10.1305","article-title":"Chronology and determinants of tissue repair in diabetic lower-extremity ulcers","volume":"40","author":"Pecoraro","year":"1991","journal-title":"Diabetes"},{"key":"2022031218200128400_B14","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1086\/424846","article-title":"Diagnosis and treatment of diabetic foot infections","volume":"39","author":"Lipsky","year":"2004","journal-title":"Clin Infect Dis"},{"key":"2022031218200128400_B15","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.jvs.2007.09.018","article-title":"Reduced primary patency rate in diabetic patients after percutaneous intervention results from more frequent presentation with limb-threatening ischemia","volume":"47","author":"DeRubertis","year":"2008","journal-title":"J Vasc Surg"},{"key":"2022031218200128400_B16","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1177\/107110078100200202","article-title":"The dysvascular foot: a system for diagnosis and treatment","volume":"2","author":"Wagner","year":"1981","journal-title":"Foot Ankle"},{"key":"2022031218200128400_B17","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1111\/j.1464-5491.1993.tb00144.x","article-title":"The description and classification of diabetic foot lesions","volume":"10","author":"Jeffcoate","year":"1993","journal-title":"Diabet Med"},{"key":"2022031218200128400_B18","doi-asserted-by":"crossref","first-page":"822","DOI":"10.2337\/dc08-1223","article-title":"Long-term prognosis of diabetic patients with critical limb ischemia: a population-based cohort study","volume":"35","author":"Faglia","year":"2009","journal-title":"Diabetes Care"},{"key":"2022031218200128400_B19","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1583\/03-1159.1","article-title":"Clinical outcome of primary infrainguinal subintimal angioplasty in diabetic patients with critical lower limb ischemia","volume":"11","author":"Lazaris","year":"2004","journal-title":"J Endovasc Ther"},{"key":"2022031218200128400_B20","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1111\/j.1464-5491.2008.02445.x","article-title":"Delivery of care to diabetic foot ulcer patients in daily practice: results of the Eurodiale study, a prospective cohort study","volume":"25","author":"Prompers","year":"2008","journal-title":"Diabet Med"},{"key":"2022031218200128400_B21","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/S1071-0949(97)80025-X","article-title":"Vascular anatomy of the foot and ankle","volume":"4","author":"Attinger","year":"1997","journal-title":"Operative Tech Plast Reconstr"},{"key":"2022031218200128400_B22","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1016\/j.ejvs.2005.02.035","article-title":"Peripheral angioplasty as the first-choice revascularization procedure in diabetic patients with critical limb ischemia: prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003","volume":"29","author":"Faglia","year":"2005","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2022031218200128400_B23","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1097\/ALN.0b013e3181948a80","article-title":"Perioperative glycemic control: an evidence-based review","volume":"110","author":"Lipshutz","year":"2009","journal-title":"Anesthesiology"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/33\/5\/977\/606259\/zdc00510000977.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/33\/5\/977\/606259\/zdc00510000977.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,12]],"date-time":"2022-03-12T19:21:01Z","timestamp":1647112861000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/33\/5\/977\/27065\/Long-Term-Outcomes-of-Diabetic-Patients-With"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2010,3,3]]},"references-count":23,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2010,3,3]]},"published-print":{"date-parts":[[2010,5,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc09-0831","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,3,3]]}}}