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Prevalence of Peripheral Arterial Disease in Patients With Diabetic Charcot Neuroarthropathy

  • Dane K. Wukich
    Correspondence
    Address correspondence to: Dane K. Wukich, MD, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 1515 Locust Street, Suite 350, Pittsburg, PA 15219.
    Affiliations
    Professor, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, and Medical Director, UPMC Mercy Center for Healing and Amputation Prevention, University of Pittsburgh Medical Center, Pittsburgh, PA
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  • Katherine M. Raspovic
    Affiliations
    Assistant Professor, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
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  • Natalie C. Suder
    Affiliations
    Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
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Published:March 25, 2016DOI:https://doi.org/10.1053/j.jfas.2016.01.051

      Abstract

      Charcot neuroarthropathy (CN) is a serious complication of diabetes mellitus (DM) that can lead to pedal ulceration, infection, hospitalization, and amputation. Peripheral arterial disease (PAD) is also found in patients with diabetic foot disease; however, its prevalence in patients with CN has not been extensively evaluated. The aim of the present study was to evaluate the prevalence of PAD in a group of patients with CN (with and without ulceration) and compare this to a group of patients with diabetic foot ulceration (DFU) and no CN. We compared the lower extremity noninvasive arterial testing results of 85 patients with DM and CN with those from a group of 126 patients with DFU and no CN. No statistically significant differences were found in age, gender, type of DM (1 versus 2), insulin use, duration of DM, or history of dialysis between our study and control groups. The prevalence of PAD in the patients with CN was 40%. Compared with patients with DFUs, the patients with CN were less likely to have PAD (odds ratio 0.48, 95% confidence interval 0.28 to 0.85; p = .0111), ischemia (odds ratio 0.33, 95% confidence interval 0.16 to 0.69; p = .0033), or the need for revascularization (odds ratio 0.27, 95% confidence interval 0.10 to 0.73; p = .0097). Critical limb ischemia (great toe pressure <30 mm Hg) was 82% less likely in patients with CN than in patients with DFU. PAD in patients with CN is not uncommon; however, ischemia and the need for revascularization were significantly less likely than in patients with DFU without CN.

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