(WHS-P4.02) ANGIOGRAPHY: A LIMB SALVAGE STRATEGY FOLLOWING LOWER EXTREMITY THERMAL INJURY IN PATIENTS WITH DIABETES MELLITUS AND PERIPHERAL ARTERY DISEASE
Friday, May 17, 2024
10:30 AM – 11:30 AM East Coast USA Time
Background Patients with diabetes mellitus (DM) or peripheral arterial disease (PAD) are at high risk of wound complications and amputations following lower extremity thermal injury. Algorithms to improve healing and limb salvage in chronic wounds from DM or PAD include angiography to facilitate peripheral blood flow analysis and revascularization. However, the role of angiography in patients with acute thermal injuries and DM or PAD have yet to be elucidated. This study describes a regional burn center’s experience incorporating angiography into the acute management of lower extremity thermal injuries in patients with DM or PAD. Methods Patients admitted with a lower extremity partial or full thickness thermal injury and history of DM or PAD between 2021 and 2023 were retrospectively reviewed. Patients with an abnormal arterial-brachial index (ABI), which prompted angiography evaluation, were included. Vascular disease identified and interventions performed during angiography were obtained. Clinical outcomes, including graft loss and amputations were evaluated. Results There were 23 patients with a lower extremity thermal injury, history of DM or PAD, and an abnormal ABI that underwent lower extremity angiography. Most patients were male (65.2%), had a thermal injury to their foot (82.6%) and had uncontrolled DM (median hemoglobin A1c of 10.2 mmol/mol). The median total body surface area (TBSA) was 2.0%. Vascular disease was identified in 18 patients (79%) by angiography. The tibial arteries were the most common site of vascular disease (87%), followed by the popliteal (14%) and superficial femoral arteries (14%). Incomplete pedal arch was identified in 5 patients (22%), with microvascular disease as the primary cause (60%). Vascular disease was amendable to re-vascularization attempts using balloon angioplasty in 9 patients (50%), with an 88.8% success rate. After re-vascularization over half of patients (55.6%) healed without grafting, while most patients without re-vascularization required further grafting (71.4%). When grafting was required, the rate of graft loss necessitating prolonged wound care or re-operation was less for patients who underwent re-vascularization (7.1% vs 14.3%). Amputations were necessary in 33.3% of patients who underwent re-vascularization compared to 14.3% of patients who did not have re-vascularization. There is not enough power to reach statistical significance. Conclusions This study is the first to describe the role of angiography in the acute management of lower extremity thermal injuries in patients with DM or PAD. We demonstrated angiography’s ability to improve vascularization in the lower extremity to promote wound healing without grafting and minimize graft loss. Further studies are needed to better understand the impact of angiography on limb salvage.