Distal Angioplasty in Diabetic Patients: A Two-Year Retrospective Study at Fann University Hospital, Dakar, Senegal

Background: Distal angioplasty has become a key therapeutic option for diabetic patients presenting with chronic limb-threatening ischemia (CLTI), particularly in settings where infrapopliteal, diffuse, and calcified lesions are predominant. Despite the growing burden of diabetes in sub-Saharan Africa, regional data remain scarce. Methods: This retrospective, single?center study included all diabetic patients who underwent distal angioplasty at Fann Hospital between January 2021 and December 2022. Clinical characteristics, cardiovascular risk factors, imaging findings, procedural techniques, and postoperative outcomes were analyzed. Results: Eighty-six patients were included (mean age 66.3 ± 7.5 years). Most presented with stage IV ischemia (84.88%). Type 2 diabetes was predominant (95.35%), with a mean duration of 14.3 years. CT angiography revealed multivessel distal disease in nearly all cases. Distal angioplasty was performed under local anesthesia in 96.52% of procedures, with antegrade puncture in 98.8%. A 3mm balloon was used in 87.2% of cases, and stenting was required in only one patient. Residual stenosis occurred in 10.47% of procedures and arterial dissection in 9.3%. Primary wound healing was achieved in 60.81% of patients, with a mean healing time of 4 months. Twenty-six amputations were performed (18 minor, 8 major). Overall mortality reached 17.4%, with hypertension significantly associated with death (p = 0.028). Median survival after angioplasty was 36 days. Conclusion: Distal angioplasty is feasible and effective in diabetic patients with severe lower?limb ischemia, even in resource-limited settings. However, high mortality highlights the need for comprehensive cardiovascular management, early PAD detection, and strengthened multidisciplinary care pathways to improve long-term outcomes.