Sulodexide for limb salvage in refractory diabetic foot ulcer with arteriosclerosis obliterans: a case report
Summary: February 12, 2026 case report describes a 77-year-old female with T2DM, severe DFU, infection, and arteriosclerosis obliterans (ASO). Despite debridement, angioplasty (ABI 0.54 to 0.92), and standard care, wound deteriorated due to persistent microcirculatory dysfunction (TcPO₂ minimal rise from 25.4 to 28.6 mmHg). Sulodexide (glycosaminoglycan: 80% low-molecular-weight heparan sulfate, 20% dermatan sulfate) initiated as salvage (600 LSU/day IV for 51 days) via vasoprotective, anti-thrombotic, hemorheological effects—repairing endothelial glycocalyx, reducing microvascular resistance/pro-thrombotic state. Outcomes: granulation formation, TcPO₂ to 53.6 mmHg, complete epithelialization by April 26, 2025, limb salvaged, no recurrence by July 15, 2025 follow-up. No adverse events; highlights sulodexide as adjunctive/salvage for post-revascularization microcirculatory failure in refractory DFU, hypothesis-generating for trials in endocrinology/diabetology contexts.
Key Highlights:
- Mechanism: Endothelial repair, improved perfusion despite macrovascular success.
- Outcomes: Full healing post-sulodexide; no recurrence/amputation.
- Implications: Targets microvascular issues in ischemic DFUs.
- Relevance: Complements advanced therapies for non-healing post-revascularization cases.
Keywords: sulodexide, refractory DFU, arteriosclerosis obliterans, microcirculatory dysfunction