Prostanoids in patients with diabetes and chronic limb-threatening ischemia: a meta-analysis of randomized clinical trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome

Excerpt

The incidence and prevalence of chronic limb-threatening ischemia (CLTI) are dramatically increasing among patients with diabetes [1]. CLTI is characterized by the presence of rest pain, gangrene, or lower limb ulceration > 2 weeks duration [1]. CLTI, in case of the absence of suitable target arterial paths for revascularization with no visible distributing arterial circulation in the foot (desert foot) and of patients with multiple comorbid conditions, can be associated with a relevant high risk of major adverse limb events (MALE: mortality and major amputation) [1]. Revascularization, including both bypass and endovascular surgery, is considered the gold standard treatment of CLTI [2]. However, it is estimated that up to 25% of diabetic patients are not eligible for revascularization due to the inability to overcome vascular obstruction and/or critical general conditions [1]. In case of no-option CLTI, the risk of major amputation and mortality considerably increases and any alternative treatments should be considered to reduce the risk of MALE. …