Endovascular Revascularization with Drug-Coated Balloon Angioplasty Combined with Advanced Wound Care in Diabetic Foot Ulcers and Peripheral Artery Disease

Objective The aim of this study was to retrospectively evaluate the efficacy of endovascular revascularization (EVR) on wound healing, amputation rates, and mortality in patients with diabetic foot ulcers (DFU) and concomitant peripheral artery disease (PAD). Methods This retrospective cohort study included 80 patients diagnosed with DFU and PAD who were followed at our clinic between 2017 and 2023. Patients were divided into two groups: those who underwent EVR (n=55) and those who received conservative treatment (n=25). Data on demographics, comorbidities, Wagner, WIfI, and GLASS classifications, wound healing outcomes, amputation, and mortality were collected. Statistical analysis was performed using chi-square and independent t-tests. Results The mean age and gender distribution were similar between the EVR and control groups. However, baseline HbA1c levels were significantly higher in the EVR group (8.2 ± 2.0 vs 7.0 ± 2.1, p=0.023), and the EVR group had a significantly higher proportion of WIfI Grade 3 (27.3% vs. 4.0%, p=0.035) and Wagner Grade 3-4 ulcers. The median follow-up duration was 4.0 months. In the unmatched cohort, complete healing was achieved in 56.4% of the EVR group compared to 44.0% in the control group (p=0.433), and the major amputation rate was higher in the EVR group (34.5% vs 12.0%, p=0.068) due to selection bias. After Propensity Score Matching (PSM) to adjust for baseline severity (n=15 per group), the complete healing rate was 73.3% in the EVR group versus 40.0% in the control group (p=0.139), and the amputation rate was 33.3% vs. 13.3% (p=0.390). Conclusion In our single-center experience, endovascular revascularization was associated with a complete healing rate of over 56% in a high-risk patient population. The absence of a statistically significant benefit compared to conservative management underscores the profound impact of baseline comorbidities and highlights the importance of patient selection. These findings emphasize that while EVR is a critical tool, it is most effective as part of a comprehensive, multidisciplinary strategy focused on aggressive glycemic control and wound care.