PTA as the first choice revascularisation procedure is feasible, safe and effective for limb salvage in a high percentage of diabetic patients. Clinical restenosis was an infrequent event and PTA could successfully be repeated in most cases.

OBJECTIVE -To evaluate the long-term prognosis of critical limb ischemia (CLI) in diabetic patients. CONCLUSIONS -Diabetic patients with CLI have high risks of amputation and death. In a dedicated diabetic foot center, the major amputation, ulcer recurrence, and major contralateral limb amputation rates were low. Coronary artery disease (CAD) is the leading cause of death, and in patients with CAD history the impaired ejection fraction is the major independent prognostic factor. RESEARCH DESIGN AND METHODS

Objective To evaluate the early and late major amputation and survival rates and related risk factors in diabetic patients with critical limb ischemia (CLI).Design Retrospective study. Methods Revascularization feasibility, major amputation, survival rate and related risk factors were recorded in 564 diabetic patients consecutively hospitalized for CLI from 1999 to 2003 and followed until June 2005.Results Peripheral angioplasty (PTA) was carried out in 420 (74.5%), bypass graft (BPG) in 117 (20.7%) patients. In 27 (4.8%) patients both PTA and BPG were not possible. Twenty-three above-the-ankle amputations (4.1%) were performed at 30 days: 6 in PTA patients, 3 in BPG patients, 14 in non revascularized patients. In the follow-up of 558 patients (98.9%), 62 repeated PTAs and 9 new BPGs, 32 new major amputations (16 in PTA patients, 14 in BPG patients and 2 in non-revascularized patients) were performed. Major amputation was associated with absence of revascularization (OR 35.9, pϽ0.001, CI 12.9 -99.7), occlusion of each of the three crural arteries (OR 8.20, pϭ0.022,), wound infection (OR 2.1, pϭ0.004 CI 1.3-3.6), dialysis (OR 4.7, pϭ0.001 CI 1.9 -11.7) increase in TcPO 2 after revascularization (OR 0.80, pϽ0.001 CI 0.74 -0.87).One hundred seventy three patients died during follow-up and this was associated with age (HR 1.05, pϽ0.001 CI 1.03-1.07), history of cardiac disease (HR 2.16, pϽ0.001 CI 1.53-3.06), dialysis (HR 3.52, pϽ0.001 CI 2.08 -5.97), absence of revascularization (HR 1.68, pϽ0.001,) and impaired ejection fraction (HR 1.08, pϽ0.001, CI 1.05-1.09).Conclusions In diabetic patients with CLI the revascularization is feasible in most cases and allows a low rate of early major amputation. This rate is higher in the follow-up period. Major amputation is very high in patients where revascularization is not feasible while the high mortality rate is due to the serious comorbidities observed in these patients.

In patients with diabetes, PTA is effective in avoiding major amputation, provided recanalization occurs in at least one tibial artery down to the foot. In a few patients, re-canalization of the peroneal artery alone is not sufficient to avoid major amputation.

This retrospective study shows that the 6F Angio-Seal is a valuable and safe vascular closure device for transbrachial access in diabetic patients undergoing interventional procedures for critical limb ischemia.

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In diabetic patients with CLI the revascularization is feasible in most cases and allows a low rate of early major amputation. This rate is higher in the follow-up period. Major amputation is very high in patients where revascularization is not feasible while the high mortality rate is due to the serious comorbidities observed in these patients.

PTA is an effective method for revascularizing secondary obstructions in patients with graft failure (and no possibility of a redo graft). PTA also is effective in at least one subgenicular artery in patients with diabetes with inadequate run-off after femoropopliteal bypass grafting.