Reduced primary patency rate in diabetic patients after percutaneous intervention results from more frequent presentation with limb-threatening ischemia

Objective Although patients with diabetes are at increased risk of amputation from peripheral vascular disease, excellent limb-salvage rates have been achieved with aggressive surgical revascularization. It is less clear whether patients with diabetes will fare as well as nondiabetics after undergoi...

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Published in:Journal of vascular surgery 2008, Vol.47 (1), p.101-108
Main Authors: DeRubertis, Brian G., MD, Pierce, Matthew, BS, Ryer, Evan J., MD, Trocciola, Susan, MD, Kent, K. Craig, MD, Faries, Peter L., MD
Format: Article
Language:English
Subjects:
Aged
Angioplasty - adverse effects
Angioplasty - instrumentation
Atherectomy - adverse effects
Biological and medical sciences
Diabetes Complications - pathology
Diabetes Complications - physiopathology
Diabetes Complications - surgery
Diseases of the cardiovascular system
Extremities - blood supply
Female
Follow-Up Studies
Humans
Ischemia - etiology
Ischemia - physiopathology
Ischemia - surgery
Limb Salvage
Male
Medical sciences
Odds Ratio
Patient Selection
Peripheral Vascular Diseases - complications
Peripheral Vascular Diseases - pathology
Peripheral Vascular Diseases - physiopathology
Peripheral Vascular Diseases - surgery
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Retrospective Studies
Risk Assessment
Risk Factors
Stents
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Time Factors
Treatment Failure
Treatment Outcome
Vascular Patency
Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
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Summary:Objective Although patients with diabetes are at increased risk of amputation from peripheral vascular disease, excellent limb-salvage rates have been achieved with aggressive surgical revascularization. It is less clear whether patients with diabetes will fare as well as nondiabetics after undergoing percutaneous lower extremity revascularization, a modality which is becoming increasingly utilized for this disease process. This study aimed to assess differential outcomes in between diabetics and nondiabetics in lower extremity percutaneous interventions. Methods We retrospectively studied 291 patients with respect to patient variables, complications, and outcomes for percutaneous interventions performed for peripheral occlusive disease between 2002 and 2005. Tibial vessel run-off was assessed by angiography. Patency (assessed arterial duplex) was expressed by Kaplan-Meier method and log-rank analysis. Mean follow-up was 11.6 months (range 1 to 56 months). Results A total of 385 interventions for peripheral occlusive disease with claudication (52.2%), rest pain (16.4%), or tissue loss (31.4%) were analyzed, including 336 primary interventions and 49 reinterventions (mean patient age 73.9 years, 50.8% male). Comorbidities included diabetes mellitus (57.2%), chronic renal insufficiency (18.4%), hemodialysis (3.8%), hypertension (81.9%), hypercholesterolemia (57%), coronary artery disease (58%), tobacco use (63.2%). Diabetics were significantly more likely to be female (55.3% vs 40.8%), and suffer from CRI (23.5% vs 12.0%), a history of myocardial infarction (36.5% vs 18.0%), and
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2007.09.018