Carbon Dioxide Angiography and Clinical Eligibility Scale for Endovascular Interventions in Neuroischemic Diabetic Foot Syndrome with Chronic Kidney Disease: A Comparative Cohort Study

Neuroischemic diabetic foot syndrome (DFS) in patients with chronic kidney disease (CKD) represents one of the most severe and prognostically unfavorable clinical scenarios, where the use of traditional iodinated contrast angiography is often limited by the risk of contrast-induced nephropathy.This leads to reduced rates of revascularization and high amputation frequency.This research amis to evaluate the effectiveness and safety of a differentiated endovascular strategy based on carbon dioxide angiography (CO₂A) and an original Clinical Eligibility Scale for Endovascular Interventions (CES-EVI) in patients with neuroischemic DFS and CKD.A total of 114 patients with neuroischemic DFS and CKD were included.The control group underwent standard diagnostic and surgical management with limited angiography.The main group received individualized treatment guided by CES-EVI and CO₂A.Patients were stratified by CKD stage (G1-G3a vs G3b-G5).Clinical assessment included metabolic, laboratory, microbiological, and angiographic evaluation.Primary outcomes were feasibility of endovascular interventions, limb salvage (anatomical and functional), renal safety, and 6-month mortality.The result shows that in the control group, revascularization was feasible in only 27.3% of cases, with high rates of major amputations (up to 52.4% in CKD G3b-G5) and renal deterioration after angiography (23.8%).In contrast, the main group achieved 100% feasibility of revascularization through CES-EVI stratification and CO₂A in 71.2% of patients.Major amputation rates were reduced 2.5-3 times, renal impairment after angiography decreased sevenfold, and limb salvage improved both anatomically (up to 100% in G1-G3a, 58.6% in G3b-G5) and functionally (100% and 72.4%, respectively).Six-month mortality was nearly halved compared to controls.The integration of CO₂ angiography and CES-EVI provides a nephro-safe, individualized approach for patients with neuroischemic DFS and CKD.This strategy significantly increases the feasibility of revascularization, reduces major amputations and postoperative complications, and improves both renal safety and survival.

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