Angioarchitectural Determinants of Limb Loss After Endovascular Treatment in Patients with Diabetic Foot Syndrome and Coronary Artery Disease

Background: Diabetic foot syndrome (DFS) combined with ischemic heart disease (IHD) represents a high-risk vascular condition frequently requiring endovascular revascularization. However, clinical outcomes remain heterogeneous, particularly in the presence of diffuse arterial disease. Objective: To evaluate angioarchitectural and procedural determinants of limb loss after endovascular treatment in patients with DFS and concomitant IHD. Methods: A retrospective single-center study included 58 patients with DFS and IHD who underwent endovascular intervention between 2015 and 2019. Patients were stratified according to clinical outcome into favorable and unfavorable groups. Angiographic parameters analyzed included number of affected arterial segments, level of involvement, vascular access strategy, and type of intervention (balloon angioplasty alone or combined with stenting). Primary endpoint was major amputation. Secondary endpoints included procedural complications and early mortality. Results: Unfavorable outcomes occurred in 37.9% of patients. Multi-segment arterial involvement (≥2 segments), extensive disease affecting ≥3 segments, and crossover vascular access were significantly more frequent in the unfavorable group (p <0.01). Combined balloon angioplasty with stenting was required more often in these patients (59.1% vs 33.3%, p <0.05). Stent occlusion, thrombosis, and early restenosis were associated with higher amputation rates. Major amputation occurred in 45.4% of patients with unfavorable outcomes, while early mortality reached 13.6%. Conclusion: Diffuse angioarchitectural involvement and procedural complexity are strongly associated with limb loss after endovascular treatment in patients with DFS and IHD. Incorporating anatomical severity into preprocedural assessment may improve risk stratification and limb salvage strategies.

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