J Korean Med Sci.  2023 May;38(21):e160. 10.3346/jkms.2023.38.e160.

Medial Arterial Calcification and the Risk of Amputation of Diabetic Foot Ulcer in Patients With Diabetic Kidney Disease

• So JM
• Park JH
• Kim JG
• Park IR
• Ha EY
• Chung SM
• Moon JS
• Park CH
• Yun WS
• Kim TG
• Kim W
• Yoon JS
• Won KC
• Lee HW

• KMID: 2542597
• DOI: http://doi.org/10.3346/jkms.2023.38.e160

Abstract

We assessed the risk factors for major amputation of diabetic foot ulcers (DFUs) in patients with diabetic kidney disease (DKD) stages 3b–5. For DFU assessment, in addition to DFU location and presence of infection, ischemia, and neuropathy, vascular calcification was assessed using the medial arterial calcification (MAC) score. Of 210 patients, 26 (12.4%) underwent major amputations. Only the location and extension of DFU, represented by Texas grade differed between the minor and major amputation groups. However, after adjusting for covariates, ulcer location of mid- or hindfoot (vs. forefoot, odds ratio [OR] = 3.27), Texas grades 2 or 3 (vs. grade 0, OR = 5.78), and severe MAC (vs. no MAC, OR = 4.46) was an independent risk factor for major amputation (all P < 0.05). The current use of antiplatelets was a possible protective factor for major amputations (OR = 0.37, P = 0.055). In conclusion, DFU with severe MAC is associated with major amputation in patients with DKD.

Keyword

Amputation; Diabetic Foot Ulcer; Diabetic Kidney Disease; Medial Arterial Calcification

Figure

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  Fig. 1 Assessment of vascular calcification using MAC. MAC was assessed in five arterial sites. A positive score of 1 was given for ≥ 2 cm calcification in the 1) dorsalis pedis, 2) lateral plantar, and 3) first metatarsal artery, or ≥ 1 cm calcification in the 4) first toe and 5) other toe arteries. (A) The anteroposterior (left) and lateral (right) views of “no MAC.” A total of one positive score was assigned to the lateral plantar artery (5.9 cm). (B) The anteroposterior (left) and lateral (right) views of “moderate MAC.” Two positive scores were assigned to the dorsalis pedis artery (5.4 cm) and first metatarsal artery (2.8 cm). (C) The anteroposterior (left) and lateral (right) views of “severe MAC.” Five positive scores were assigned for the dorsalis pedis artery (8.0 cm), lateral plantar artery (5.6 cm), first metatarsal artery (2.1 cm), first toe artery (3.9 cm), and third toe artery (1.7 cm).MAC = medial arterial calcification.

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