Polyvascular Disease Worsens Outcomes in Diabetic Foot Ulcer Patients, Study Finds

"Patients with polyvascular disease hospitalized for diabetic foot ulcers had significantly poorer outcomes—higher in-hospital MACE or death (12.5% vs. 4.4%), more amputations (67.4% vs. 48.4%), increased 1-year mortality (33.0% vs. 12.1%), and shorter median survival (2.0 vs. 5.9 years)," the researchers reported.

The retrospective study reviewed data from 537 adult patients who were admitted to a dedicated diabetic foot unit between 2014 and 2019. Nearly half of these patients (264 individuals) were identified with PD, which involves simultaneous clinical involvement of at least two of the three major vascular beds—coronary, cerebrovascular, and peripheral arteries.

Based on the study, the researchers reported the following findings:

• 12.5% of patients with polyvascular disease (PD) experienced major adverse cardiovascular events (MACE) or death during hospitalization, compared to 4.4% of those without PD.
• 42% of PD patients underwent vascular procedures, in contrast to 19.4% of non-PD patients.
• Overall amputation rates were higher in PD patients (67.4%) than in those without PD (48.4%).
• Major amputations occurred in 35.6% of PD patients versus 13.2% in non-PD patients.
• The median hospital stay was 19 days for PD patients compared to 17 days for those without PD.
• The one-year mortality rate was 33.0% in the PD group, nearly three times higher than the 12.1% observed in non-PD patients.
• Median survival during a 3.3-year follow-up was significantly lower in PD patients (2.0 years) compared to those without PD (5.9 years).

These findings emphasize that DFUs in the setting of polyvascular disease should be viewed not merely as localized infections or wounds but as indicators of severe systemic vascular pathology. The authors emphasize the necessity of comprehensive cardiovascular risk management, recommending that patients with both DFU and PD be prioritized for guideline-based medical therapy and more aggressive inpatient and post-discharge care.

Given the high morbidity and mortality associated with this patient group, the study highlights an urgent need for clinicians to adopt a more integrated and proactive approach when treating patients with diabetic foot ulcers, especially those with established polyvascular disease.

"By addressing both the ulcer and the broader vascular health of the patient, healthcare providers may be able to improve not only immediate outcomes but also long-term survival for this high-risk population," the authors concluded.

Reference:

Tal, N., Hershkowitz, I., Gorin, K., Leibovitch, M., Peled, S., Olshtain-Pops, K., Lorber, J., Fisher-Negev, T., Tsur, A., Haze, A., Gellman, Y. N., & Cahn, A. (2025). Clinical outcomes of patients with Polyvascular disease admitted with an acute diabetic foot ulcer. Journal of Diabetes and its Complications, 109109. https://doi.org/10.1016/j.jdiacomp.2025.109109