Abstract:

Objective To analyze the factors that influence pathological changes of pedal arch for patients with critical limb ischemia (CLI) who suffer from ischemic ulcers. Methods The clinical data of 152 CLI patients with ischemic ulcers were retrospectively analyzed. The age, sex, smoking history, hypertension history, course of diabetes, body mass, and blood biochemical indexes were recorded. According to angiography results of the pedal arch, patients were divided into two groups, i.e. the good pedal arch group (n=37) and poor pedal arch group (n=115). The factors that influenced pathological changes of pedal arch were analyzed by single variate and multi-variate Logistic regression models. Results The fasting blood glucose (FBG) and mean platelet volume (MPV) of the poor pedal arch group were significantly higher than those of the good pedal arch group (P<0.05, P<0.01). The number of patients of the poor pedal arch group who suffered from diabetes for more than 10 years was far more than that of the good pedal arch group (P<0.001). The Logistic regression analysis showed that FBG, MPV, and diabetes history ≥10 years were independent risk factors of poor pedal arch (P<0.05). The receiver operating characteristic (ROC) curve indicated that the best cut-off value and the area under the ROC curve of FBG for predicting poor pedal arch were 6.60 mmol/L and 0.805 (P<0.05). The best cut-off value and the area under the ROC curve of MPV were 11.70 fl and 0.907 (P<0.05). Patients were divided into two groups based on cut-off points of FBG and MPV and diabetes duration ≥10 years. The results of Logistic regression analysis showed that the risk of incidence of poor pedal arch for patients with FBG≥6.60 mmol/L, MPV≥11.70 fl, and diabetes duration≥10 years was 8.684 times higher than that of patients with FBG<6.60 mmol/L (95%CI=3.496-21.571, P<0.05), 12.737 times higher than that of patients with MPV＜11.70 fl (95%CI=5.358-30.232, P<0.05), and 7.75 times higher than that of patients with diabetes duration<10 years (95%CI=2.996-20.048, P<0.05). Conclusion Increased FBG and MPV, and diabetes duration ≥10 years are independent risk factors of predicting poor pedal arch for CLI patients with ischemic ulcers.

Key words: critical limb ischemia, ischemic ulcer, pedal arch, diabetes, fasting blood glucose, mean platelet volume