Published online Nov 15, 2026. doi: 10.4239/wjd.124667
Revised: July 17, 2026
Accepted: September 18, 2026
Published online: November 15, 2026
Processing time: 137 Days and 15.6 Hours
Diabetic foot ischemia is a severe macrovascular complication of peripheral artery disease that critically restricts blood flow to the lower extremities, severely com
To evaluate whether angiosome-targeted endovascular revascularization is associated with superior wound healing and limb salvage compared with non-targeted revascularization in patients with diabetic foot ischemia.
A retrospective single-center cohort study was conducted. All consecutive patients with diabetic foot ischemia undergoing endovascular revascularization at Hamad General Hospital, Hamad Medical Corporation, from January 2017 to March 2025 were included. Procedure types were classified into 3 groups: targeted-only (n = 33), non-targeted-only (n = 74), and combined targeted and non-targeted (n = 35). Primary outcomes were wound healing and limb salvage. Multivariable logistic regression was used to identify independent predictors of each outcome, with non-targeted-only as the reference group.
In total, 142 patients were analyzed (mean age 65.4 ± 12.0 years; 69.7% male). Technical success was significantly lower in the targeted-only group (69.7%) than in the non-targeted-only (91.9%) and combined (91.4%) groups (P = 0.005). No significant differences were observed in wound healing (48.5% vs 51.4% vs 41.2%; P = 0.617), limb salvage (75.8% vs 76.7% vs 80.0%; P = 0.903), or major amputation rates (P = 0.888). In multivariable analysis, procedure group was not an independent predictor of either limb salvage [area under the receiver-operating characteristic curve (AUC) = 0.661; model likelihood ratio P = 0.359] or wound healing (AUC = 0.770; P = 0.0001). Independent predictors of wound healing were older age [odds ratio (OR) = 1.05, 95% confidence interval (95%CI): 1.02–1.09; P = 0.004], lower Wagner grade (OR = 0.52, 95%CI: 0.32–0.86; P = 0.010), and longer follow-up (OR = 1.41, 95%CI: 1.13–1.76; P = 0.002).
This study, conducted in a country with a high prevalence of diabetes mellitus, found no statistically significant association between angiosome-targeted revascularization and wound healing or limb salvage compared with non-targeted revascularization. Wound severity and follow-up duration were the dominant predictors of clinical outcomes. These findings should be interpreted in the context of the study’s retrospective design and moderate sample size. Prospective multicenter studies are warranted.
Core Tip: In a country with a high prevalence of diabetes mellitus, this study examined patients with diabetic foot ischemia undergoing endovascular revascularization. Angiosome-targeted revascularization showed no statistically significant association with wound healing, major amputation, or limb salvage compared with non-targeted or combined revascularization. Multivariable logistic regression identified wound severity (Wagner grade), patient age, and follow-up duration as the dominant independent predictors of wound healing, while procedure group was not an independent predictor of either primary outcome. These findings were consistent across all prespecified subgroup and sensitivity analyses. Prospective multicenter studies are warranted.