Pattern of Vascular Insufficiency on Ultrasound Colour Doppler and Computed Tomographic Angiography in Patients with Diabetic Foot and Its Clinical Outcome

Purpose: To study the pattern of vascular insufficiency in patients with Diabetic foot using Ultrasound Color Doppler (UCD) and Computerized Tomographic (CTA) Angiography and determine its association with clinical outcome. Material and methods: This prospective study was conducted at tertiary care institute recruiting patients >18 years of age with diabetic foot having serum creatinine <1.2 mg/dl and blood urea <40 mg/dl. Diabetic foot patients who have previously undergone revascularization surgery were excluded from the study. Ultrasound parameters like color, flow, calibre, plaque, peak systolic velocity, pulsatility index, resistance index was studied in lower limb vessels and CTA was deployed to know the exact level and extent level of occlusion, calcification and presence of collaterals. Clinical outcome was studied in terms of admissions, minor and major amputations and mortality. Results: There were 65 patients (130 limbs; mean age: 58.49 ± 11.04 years) with male predilection (83.08 %). On UCD, the above knee arteries had predominantly good color and triphasic flow while broadening of the spectrum and monophasic flow was seen in below knee vessels. Dorsalis pedis artery had the lowest peak systolic velocity (58.44 ± 39.59 cm/s) and resistance index (0.82 ± 0.31). Atheromatous plaques were predominant in all vessels. On CTA, occlusion was seen more in the posterior tibial artery (n=40/130) while calcification was predominant in the femoral artery (n=59/130). Collaterals were present in 36.9% limbs. On logistic regression, low resistance index and biphasic flow of dorsalis pedis artery on UCD and calcification in the peroneal artery CTA could predict high rate of minor amputations. Conclusion: Involvement of infrapopliteal vessels especially the involvement of dorsalis pedis and common peroneal artery could have a bearing on the rate of minor amputations.