The Effect of Atherosclerotic Load on Transmetatarsal Amputation Failure in Patients with Diabetic Foot

Objective: The aim of this retrospective study was to investigate predictabilty of transmetatarsal amputation (TMA) failure in patients with diabetic foot with peripheral arterial disease.Materials and Methods: Between January 2015 and November 2018, patients with diabetic foot, who had been followed up for 12 months after having TMA were evaluated. Atherosclerotic load was calculated from conventional angiographic images by using the modified Bollinger angiogram scoring method. Patients were classified as reamputation and non-reamputation groups after TMA at 12 months. Statistical difference analysis of atherosclerotic load was made between two groups.Results: Twenty-seven diabetic foot patients whom have had TMA and angiographies before TMA were included in the study cohort. In the 12 month study period, 6 (22.2%) patients have had reamputation after TMA. The mean angiogram scores of reamputation group and non-reamputation group were 47.3 (+/- 11.4) and 15.5 (+/- 9.2), respectively. There was a statistically significant difference between the mean angiogram scoring of the two groups (p<0.001). Correlation was found between atherosclerotic load and TMA failure (r:-0,694, p<0.001). Receiver -operating characteristic curve analysis suggested that the optimum angiographic score cut-off value for reamputation at 12 month period was 29.5, with 100% sensitivity and 90.5% specificity.Conclusion: Atherosclerotic load of lower limb arteries is associated with TMA failure. Atherosclerotic load that was calculated by using modified Bollinger angiographic score system can be used to predict TMA failure.