Managing Peripheral Artery Disease in Diabetic Patients: A Questionnaire Survey from Vascular Centers of the Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS)

Felice Pecoraro, Guido Bajardi, Ben R. Saleem, Bianca Pane, Raffaele Pulli, Mohamed N. Bouayed, Liborio Ferrante, Patrizio Castelli, Andrea Stella, Vincenzo De Luca, Anna Maria Giribono, Olivier Goeau-Brissonniere, Umberto Marcello Bracale, Raffaele Pio Ammollo, Emad A. Hussein, Anna Maria Giribono, Tarek Sraieb, Maddalena Illario, Francesco Setacci, Tarek SraiebMaurizio Taurino, Giancarlo Bracale, Carlo Setacci, Jamal J. Hoballah, Matteo Tozzi, Gianmarco De Donato, Patrizio Castelli, Bruno Gossetti

Research output: Contribution to journalArticle

Abstract

Background: The Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS) was founded on October 1, 2018, to enhance cooperation among vascular professionals within Mediterranean countries. Due to its prominent social and economic impact on national health systems, diabetic arteriopathy has been selected as the very first topic to be investigated by the federation. Methods: MeFAVS members were asked to reply to a questionnaire on the management of diabetic ischemic foot. Results were collected and analyzed statistically. The questionnaire consisted of 15 multiple choice answers regarding diabetic foot (DF) diagnosis and treatment. The questionnaire was submitted to 21 centers on April 20, 2019. Results: Response rate was 62%. The survey revealed that vascular surgeons, diabetologists, and wound care nurses made-up the core of the diabetic teams present in 76.9%, 69.3%, and 92.3% of the centers, respectively. Diabetic teams were most often led by vascular surgeons (53.8%) and diabetologists (42.2%), but only in 7.9% of cases by nurses. Duplex ultrasonography and computed tomographic angiography were the most commonly available tools used to assess diabetic peripheral arterial disease (PAD). Surgical wound care was undertaken by vascular surgeons in the majority of cases, and only in 46.2% of the cases to orthopedic or plastic surgeons, while nonsurgical wound care was handled by specialized nurses (76.6%) and diabetologists (53.8%). First-line revascularization was preferred over conservative treatment (61.5% vs 53.8%) and endovascular strategy (45.3%) over open (33.7%) or hybrid (21.0%) surgery. Vascular surgeons and interventional radiologists were found to be the most common performers of endovascular revascularization (92.3% and 53.8%, respectively). Amputations had an overall rate of 16.6% (range 4–30%) and a mean reintervention rate of 22.5%, and were usually performed by vascular surgeons for both minor and major interventions (84.6%) followed by orthopedic surgeons (15.4% minor and 30.8% major). The availability of a DF clinic (84.6%) and endovascular (53.8%) and open surgery (46.2%) capabilities were considered fundamental to reduce amputation rates. Conclusions: Especially since the introduction and spreading of new endovascular techniques for the treatment of DF, it is a common consensus amongst vascular surgeons that a standardized approach to the discipline is necessary in order to improve outcomes such as amputation-free survival and mortality and it is with this perspective and purpose that transnational cooperation amongst vascular professionals and residents in training are aiming for greater proficiency in endovascular and open surgery.
Original languageEnglish
Pages (from-to)239-245
Number of pages7
JournalAnnals of Vascular Surgery
Volume64
Publication statusPublished - 2020

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

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    Pecoraro, F., Bajardi, G., Saleem, B. R., Pane, B., Pulli, R., Bouayed, M. N., Ferrante, L., Castelli, P., Stella, A., De Luca, V., Giribono, A. M., Goeau-Brissonniere, O., Bracale, U. M., Ammollo, R. P., Hussein, E. A., Giribono, A. M., Sraieb, T., Illario, M., Setacci, F., ... Gossetti, B. (2020). Managing Peripheral Artery Disease in Diabetic Patients: A Questionnaire Survey from Vascular Centers of the Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS). Annals of Vascular Surgery, 64, 239-245.