The International Journal of Lower Extremity Wounds XX(X) 1–7 © The Author(s) 2012 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1534734612448384 http://ijl.sagepub.com The increasing incidence of diabetes worldwide creates a problem of health care, both for the disease per se and for its chronic complications. 1 Complications at the lower limb (LLC) are, among those related to diabetes, the most prevalent and relevant, both from clinical and social points of view: diabetes is now the major cause of nontraumatic amputation of the lower extremities (LEA), and the trend is positive because of the increasing prevalence of diabetes and the longer life expec- tancy of patients. 2 Critical limb ischemia (CLI) plays a crucial role in deter- mining the fate of the patients with LLC, since it exposes them to a risk of amputation, which is almost 60 times higher than that of nonischemic patients. 3 Until recent times patients with CLI unavoidably ended with an LEA after a long clinical course characterized by rest pain, often not easily controlled by analgesics; foot infections; necrosis; and gangrene. 4-6 Besides this local extremely severe prognosis, a higher mortality rate due to severe comorbidities was registered in many studies, which provided evidence to show how CLI in 448384IJL XX X 10.1177/1534734612448384Scatena et alThe International Journal of Lower Extremity Wounds 2012© The Author(s) 2011 Reprints and permission: sagepub.com/journalsPermissions.nav 1 Diabetic Foot Section, Department of Medicine, Azienda Ospedaliero- Universitaria Pisana 2 Section of Interventional Radiology, Imaging Department, Azienda Ospedaliero-Universitaria Pisana 3 Vascular Surgery Unit, Cardiothoracic Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy Corresponding Author: Alberto Piaggesi, Diabetic Foot Section, Department of Medicine, University Hospital of Pisa,Via Paradisa 2, 56124 Pisa, Italy Email: piaggesi@immr.med.unipi.it Outcomes of Three Years of Teamwork on Critical Limb Ischemia in Patients With Diabetes and Foot Lesions Alessia Scatena, MD 1 , Pasquale Petruzzi, MD 2 , Mauro Ferrari, MD 3 , Loredana Rizzo, MD 1 , Antonello Cicorelli, MD 2 , Raffaella Berchiolli, MD 3 , Chiara Goretti, MD 1 , Irene Bargellini, MD 2 , Daniele Adami, MD 3 , Elisabetta Iacopi, MD 1 , Andrea Del Corso, MD 3 , Roberto Cioni, MD 2 , and Alberto Piaggesi, MD 1 Abstract To evaluate the outcomes of a multidisciplinary team working on diabetic foot (DF) patients with critical limb ischemia (CLI) in a specialized center, the authors retrospectively traced all the patients admitted in their department in 3 consecutive years with a diagnosis of CLI. From January 2006 to December 2008, 245 consecutive DF patients with CLI according the TransAtlantic interSociety Consensus II criteria were included in the study. Treatment strategy was decided by a team of diabetologists, inteventional radiologists, and vascular surgeons.Technical and clinical success, mortality, and ulcer recurrence were evaluated at 6 months and at a mean follow-up of 19.5 ± 13.4 months. Percutaneous transluminal angioplasty (PTA) was performed in 189 (77%) patients, whereas medical treatment, open surgical revascularization (OSR), and primary amputation were performed in 44 (18.3%), 11 (4.3%), and 1 (0.5%) patients, respectively. Revascularization was successful in 227/233 (97.4%) patients. At follow-up, the overall clinical success rate was 60.4%; it was significantly (P = .001) higher after revascularization (75.9%) compared with medical treatment (48.3%). During follow-up, surgical interventions in the foot were 1.5 ± 0.4 in those treated with PTA, 1.6 ± 0.5 in those treated with OSR, and 0.3 ± 0.8 in those receiving medical therapy (P < .05 compared with the others). Ulcer recurrence occurred in 29 (11.8%) patients: 4 (1.6%) in PTA, 2 (0.8%) in OSR, and 23 (9.4%) in the medical therapy group (P < .05). Major amputation rate was 9.3%, being significantly (P = .04) lower after revascularization (5.2%) compared with medical therapy alone (13.8%). Cumulative mortality rate was 10.6%. In conclusion, this study confirms the positive role of a PTA-first approach for revascularizing the complex cases of DF with CLI in a teamwork management strategy. Keywords critical limb ischemia, diabetes, diabetic foot, revascularization, teamwork