The management of ischemic heel ulcers and gangrene in the endovascular era

Dosluoglu, Hasan H.; Attuwaybi, Bashir; Cherr, Gregory S.; Harris, Linda M.; Dryjski, Maciej L.

doi:10.1016/j.amjsurg.2007.08.008

« Previous Next »The American Journal of Surgery
Volume 194, Issue 5 , Pages 600-605, November 2007

The management of ischemic heel ulcers and gangrene in the endovascular era

Presented at the 31st Annual Surgical Symposium of the Association of VA Surgeons, Little Rock, AR, May 10–12, 2007

Hasan H. Dosluoglu, M.D.
- Division of Vascular Surgery, Veterans Administration Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY 14215, USA
- Department of Surgery, State University of New York at Buffalo, Buffalo General Hospital, 100 High Street, Buffalo, NY 14203, USA
- Division of Vascular Surgery, State University of New York at Buffalo, Millard Fillmore Hospital, Gates Circle, Buffalo, NY 14209, USA
- Corresponding author. Tel.: +1-716-862-8937; fax: +1-716-862-8600.
Bashir Attuwaybi, M.D.
- Department of Surgery, State University of New York at Buffalo, Buffalo General Hospital, 100 High Street, Buffalo, NY 14203, USA
Gregory S. Cherr, M.D.
- Department of Surgery, State University of New York at Buffalo, Buffalo General Hospital, 100 High Street, Buffalo, NY 14203, USA
- Division of Vascular Surgery, State University of New York at Buffalo, Millard Fillmore Hospital, Gates Circle, Buffalo, NY 14209, USA
Linda M. Harris, M.D.
- Department of Surgery, State University of New York at Buffalo, Buffalo General Hospital, 100 High Street, Buffalo, NY 14203, USA
- Division of Vascular Surgery, State University of New York at Buffalo, Millard Fillmore Hospital, Gates Circle, Buffalo, NY 14209, USA
Maciej L. Dryjski, M.D.
- Department of Surgery, State University of New York at Buffalo, Buffalo General Hospital, 100 High Street, Buffalo, NY 14203, USA
- Division of Vascular Surgery, State University of New York at Buffalo, Millard Fillmore Hospital, Gates Circle, Buffalo, NY 14209, USA

Received 24 May 2007; received in revised form 8 July 2007

Abstract

Background

The objective of this study was to compare the outcome of patients presenting with heel ulcers or gangrene (HEEL group) with those having lesions in other parts of the foot (non-HEEL group).

Methods

Treatment and outcomes of all HEEL and non-HEEL patients between June 2001 and October 2006 were compared.

Results

Three hundred eight patients were treated (71 HEEL and 237 non-HEEL). The HEEL group was more frequently nonambulatory, had lower albumin levels, and had gangrene. The primary amputation rate (11% vs 3%, P < .001) was higher in HEEL patients, and more endovascular interventions were also performed in the HEEL group (75% vs 55%, P = .015). The 24-month limb salvage and patency rates were similar; but survival was worse in HEEL patients. Serum albumin <3 g/dL, dialysis dependence, and gangrene were associated with limb loss in the HEEL group. Mean time to healing was 4.3 ± 3.4 months.

Conclusions

Patients with ischemic heel ulcers or gangrene were more likely to undergo primary amputation; however, limb salvage rates were similar to those of non-HEEL patients after attempted salvage. Endovascular interventions currently play a significant role in the management of these patients. Gangrene, serum albumin <3 g/dL, and dialysis dependence resulted in increased limb loss in patients with ischemic heel lesions.

Keywords: Critical limb ischemia, Endovascular interventions, Heel, Limb salvage