{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:33:01Z","timestamp":1791592381445,"version":"4.3.4"},"reference-count":24,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2020,11,21]],"date-time":"2020-11-21T00:00:00Z","timestamp":1605916800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The study aimed to evaluate clinical and vascular characteristics, as well as outcomes, for diabetic persons with foot ulceration and no-option critical limb ischemia (CLI). The study group included a sample of patients admitted to our diabetic foot unit because of a new diabetic foot ulcer and CLI. All subjects were managed using a limb salvage protocol which includes lower-limb revascularization. According to whether or not the revascularization procedure was a success, patients were respectively divided into two groups: successfully treated CLI patients (ST-CLI) and no-option CLI patients (NO-CLI). Failed revascularization was considered in the case of technical recanalization failure of occluded vessels (inability to overcome the obstruction) and\/or absence of arterial flow to the foot. Limb salvage, major amputation, and death after 1 year of follow-up were evaluated and compared between the two groups. Overall, 239 patients were included, 74.9% belonging to ST-CLI and 25.1% to NO-CLI. NO-CLI patients reported more cases of ischemic heart disease (80 vs. 62.1, p = 0.008), heart failure (63.3 vs. 32.4%, p &lt; 0.0001), and end-stage renal disease (ESRD) (60 vs. 25.7%) than ST-CLI patients. In addition, more vessels were affected in the NO-CLI group (5.2 \u00b1 1.6 vs. 4 \u00b1 1.5, p &lt; 0.0001), and there was more involvement of tibio-peroneal trunk (50 vs. 30.2%, p = 0.006), anterior tibial (93.3 vs. 82.7, p = 0.03), posterior tibial (93.3 vs. 73.7%, p = 0.0005), peroneal (70 vs. 48%, p = 0.002), and below-the-ankle arteries (73.3 vs. 39.1%, p &lt; 0.0001) than ST-CLI. The 1 year outcomes for the whole population were 69.9% limb salvage, 10.9% major amputation, and 19.2% death. The outcomes for NO-CLI and ST-CLI were, respectively, as follows: limb salvage (13.8 vs. 73.4%, p &lt; 0.0001), amputation (30 vs. 4.5%, p = 0.0001), and mortality (50 vs. 8.9%, p &lt; 0.0001). NO-CLI patients showed a more severe pattern of peripheral arterial disease (PAD) with distal arterial lesions and worse outcomes than ST-CLI.<\/jats:p>","DOI":"10.3390\/jcm9113745","type":"journal-article","created":{"date-parts":[[2020,11,23]],"date-time":"2020-11-23T11:50:34Z","timestamp":1606132234000},"page":"3745","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Characteristics and Outcome for Persons with Diabetic Foot Ulcer and No-Option Critical Limb Ischemia"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3789-9622","authenticated-orcid":false,"given":"Marco","family":"Meloni","sequence":"first","affiliation":[{"name":"Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Izzo","sequence":"additional","affiliation":[{"name":"Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerio","family":"Da Ros","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Morosetti","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Stefanini","sequence":"additional","affiliation":[{"name":"Department of Radiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9008-4687","authenticated-orcid":false,"given":"Enrico","family":"Brocco","sequence":"additional","affiliation":[{"name":"Department of Foot and Ankle, Polyclinic Abano Terme, 35031 Abano Terme, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Giurato","sequence":"additional","affiliation":[{"name":"Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Gandini","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5087-2091","authenticated-orcid":false,"given":"Luigi","family":"Uccioli","sequence":"additional","affiliation":[{"name":"Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,11,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e3266","DOI":"10.1002\/dmrr.3266","article-title":"IWGDF Editorial Board Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update)","volume":"36","author":"Schaper","year":"2020","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1002\/dmrr.2249","article-title":"A systematic review of the effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral arterial disease","volume":"28","author":"Hinchliffe","year":"2012","journal-title":"Diabetes\/Metabolism Res. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.diabres.2019.04.031","article-title":"Below-the-ankle arterial disease severely impairs the outcomes of diabetic patients with ischemic foot ulcers","volume":"152","author":"Meloni","year":"2019","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Meloni, M., Izzo, V., Giurato, L., L\u00e1zaro-Mart\u00ednez, J.L., and Uccioli, L. (2020). Prevalence, Clinical Aspects and Outcomes in a Large Cohort of Persons with Diabetic Foot Disease: Comparison between Neuropathic and Ischemic Ulcers. J. Clin. Med., 9.","DOI":"10.3390\/jcm9061780"},{"key":"ref_5","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":"32","author":"Faglia","year":"2009","journal-title":"Diabetes Care"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"(2014). Standards of Medical Care in Diabetes. Majmaah J. Health Sci., 2, 64.","DOI":"10.12816\/0004790"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S5A","DOI":"10.1016\/j.jvs.2006.12.037","article-title":"On behalf of the TASC II Working Group","volume":"45","author":"Norgren","year":"2007","journal-title":"J. Vasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.numecd.2013.12.007","article-title":"Treatment of peripheral arterial disease in diabetes: A consensus of the Italian Societies of Diabetes (SID, AMD), Radiology (SIRM) and Vascular Endovascular Surgery (SICVE)","volume":"24","author":"Aiello","year":"2014","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1002\/dmrr.2705","article-title":"Effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral artery disease: A systematic review","volume":"32","author":"Hinchliffe","year":"2016","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"63","DOI":"10.2147\/VHRM.S125065","article-title":"Critical limb ischemia: Current challenges and future prospects","volume":"14","author":"Uccioli","year":"2018","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.ejvs.2008.12.001","article-title":"Long-term Outcomes after Angioplasty of Isolated, Below-the-knee Arteries in Diabetic Patients with Critical Limb Ischaemia","volume":"37","author":"Ferraresi","year":"2009","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"977","DOI":"10.2337\/dc09-0831","article-title":"Long-Term Outcomes of Diabetic Patients with Critical Limb Ischemia Followed in a Tertiary Referral Diabetic Foot Clinic","volume":"33","author":"Uccioli","year":"2010","journal-title":"Diabetes Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1696012","DOI":"10.1080\/2000625X.2019.1696012","article-title":"Limb salvage in diabetic patients with no-option critical limb ischemia: Outcomes of a specialized center experience","volume":"10","author":"Paola","year":"2019","journal-title":"Diabet. Foot Ankle"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.ejvs.2006.11.022","article-title":"Vascular Involvement in Diabetic Subjects with Ischemic Foot Ulcer: A New Morphologic Categorization of Disease Severity","volume":"33","author":"Graziani","year":"2007","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"655","DOI":"10.23736\/S0021-9509.18.10572-6","article-title":"BAD transmission and SAD distribution: A new scenario for critical limb ischemia","volume":"59","author":"Ferraresi","year":"2018","journal-title":"J. Cardiovasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1177\/1526602820933880","article-title":"Infrapopliteal Anatomic Severity and Delayed Wound Healing in Patients with Chronic Limb-Threatening Ischemia in the Era of the Global Limb Anatomic Staging System","volume":"27","author":"Hata","year":"2020","journal-title":"J. Endovasc. Ther."},{"key":"ref_17","unstructured":"(2020). Peripheral arterial disease in persons with renal-diabetic foot ulcers. J. Wound Care., in press."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/S1078-5884(96)80044-X","article-title":"Outcome of unreconstructed chronic critical leg ischaemia","volume":"11","year":"1996","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.ejvs.2013.04.013","article-title":"Outcome of Ischemic Foot Ulcer in Diabetic Patients Who Had no Invasive Vascular Intervention","volume":"46","author":"Elgzyri","year":"2013","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1016\/j.jvs.2011.02.006","article-title":"Factors related to outcome of neuroischemic\/ischemic foot ulcer in diabetic patients","volume":"53","author":"Apelqvist","year":"2011","journal-title":"J. Vasc. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1007\/s00125-008-1226-2","article-title":"Complexity of factors related to outcome of neuropathic and neuroischaemic\/ischaemic diabetic foot ulcers: A cohort study","volume":"52","author":"Gershater","year":"2008","journal-title":"Diabetology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.diabres.2016.04.030","article-title":"Long term outcomes of diabetic haemodialysis patients with critical limb ischemia and foot ulcer","volume":"116","author":"Meloni","year":"2016","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1111\/1753-0407.12062","article-title":"Heart failure in hospitalized patients with diabetic foot ulcers: Clinical characteristics and their relationship with prognosis","volume":"5","author":"Xu","year":"2013","journal-title":"J. Diabetes"},{"key":"ref_24","first-page":"31","article-title":"Impact of heart failure and dialysis in the prognosis of diabetic patients with ischemic foot ulcers","volume":"11","author":"Meloni","year":"2018","journal-title":"J. Clin. Transl. Endocrinol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/11\/3745\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:35:17Z","timestamp":1760178917000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/11\/3745"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,21]]},"references-count":24,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,11]]}},"alternative-id":["jcm9113745"],"URL":"https:\/\/doi.org\/10.3390\/jcm9113745","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,21]]}}}