Endovascular first for every diabetic heel wound? Not so fast…

Terrific work from our long-time friends and colleagues from Lund. Enjoy!



Heel ulcers in patients with diabetes mellitus (DM) and peripheral arterial disease (PAD) are hard to heal. The aim of the present study was to evaluate the difference in amputation-free survival (AFS) between open and endovascular revascularization in patients with DM, PAD, and heel ulcers.


Retrospective comparative study of results of open versus endovascular surgery in patients with DM, PAD, and heel ulcer presented at the multidisciplinary diabetes foot clinic between 1983 and 2013.


Patients with heel ulcers were treated with endovascular intervention (n = 97) and open vascular surgery (n = 30). Kaplan-Meier analysis showed that the AFS was higher in patients undergoing open vascular surgery compared to the endovascular group (P = .009). Multivariate analysis showed that open vascular surgery versus endovascular therapy (hazard ratio 2.1, 95% confidence interval 1.1-3.9; P = .025) was an independent factor associated with higher AFS. The proportion of patients undergoing endovascular therapy in the former (1983-2000) time period was 47% compared to 89% in the latter (2001-2013) time period (P < .001).


The AFS was higher after open than endovascular surgery among patients with DM and PAD with heel ulcer. These results suggest that open vascular surgery should be offered more often as opposed to current practice.Keywords diabetes mellitusheel ulcerperipheral arterial diseaseendovascular surgeryopen vascular surgeryamputation-free survival

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  1. Faculty of Health and Medical Sciences
    Faculty of Health and Medical Sciences
    University of Copenhagen
    Blegdamsvej 3B
    2200 Copenhagen N
    Head of Media Relations Kristine Snedker, kristine.snedker@sund.ku.dk, (+45) 23 64 88 42

    Faculty of Health and Medical Sciences
    13 March 2019
    Discovery of how organs form helps stem cell researchers in their quest to develop future treatments of diabetes and cancer
    I am proud to tell you that we are the only ones in the world who can treat, and protect against all diabetic complications with the same treatment

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