Efficacy of endoluminal interventional therapy in diabetic peripheral arterial occlusive disease: a retrospective trial

Abstract

Background: The purpose of this study was to assess the efficacy of interventional therapy for peripheral arterial occlusive disease and the difference between diabetic patients and non-diabetic patients.Methods: 139 consecutive patients between September 2006 and September 2010 who underwent percutaneous lower extremity revascularization for arterial lesions were divided into diabetes group (n = 62) and non-diabetes group (n = 77). Before intervention, rest ankle brachial indexes and three dimensional computed tomography angiography from abdominal aorta to tiptoe were performed. The interventional treatments included angioplasty with or without stenting. The clinical outcomes included rest ankle-brachial indexes, primary patency rates, secondary patency rates and limb-salvage rates for 6-month, 12-month, 24-month and 36-month after treatment. The primary and secondary patency rates of all interventions and the limb-salvage rates of the patients are illustrated by Kaplan-Meier curves and compared by log-rank analysis. Results: The interventional operation success rates were 98.4% (61/62) in diabetes group and 100% (77/77) in nondiabetes group. The re-interventional operation success rates were 85.7% (18/21) in diabetes group and 76.9% (20/ 26) in non-diabetes group. The mean value of ankle brachial indexes was significantly increased after intervention (0.397 ± 0.125 versus 0.779 ± 0.137, t = -25.780, P < 0.001) in diabetes group and (0.406 ± 0.101 versus 0.786 ± 0.121, t = -37.221, P < 0.001) in non-diabetes group. Perioperative 30-day mortality was 0%. Major complications included groin hematoma in 7.2%, and pseudoaneurysm formation 2.2%. In diabetes group, 6, 12, 24, and 36month primary patency rates were 88.7% ± 4.0%, 62.3% ± 6.6%, 55.3% ± 7.0%, and 46.5% ± 7.5%; secondary patency rates were 93.5% ± 3.1%, 82.3% ± 5.1%, 70.8% ± 6.5%, and 65.7% ± 7%; limb-salvage rates were 95.2% ± 2.7%, 87.7% ± 4.4%, 85.5% ± 4.8%, and 81.9% ± 5.8%. In non-diabetes group, 6, 12, 24, and 36-month primary patency rates were 90.9% ± 3.3%, 71.8% ± 5.4%, 71.8% ± 5.4%, and 60.9% ± 6.2%; secondary patency rates were 96.1% ± 2.2%, 91.6% ± 3.3%, 82.7% ± 4.8%, and 71.8% ± 6.2%; limb-salvage rates were 97.4% ± 1.8%, 94.4% ± 2.7%, 90.6% ± 3.7%, and 83.1% ± 5.4%. The differences between two groups were not significant (P > 0.05). Conclusion:With a low risk of morbidity and mortality, the percutaneous revascularization accepted by patients does not affect ultimate necessary surgical revascularization and consequently should be considered as the preferred therapy for chronic lower extremity ischemia. The efficacy and prognosis of interventional therapy in diabetic patients is similar that in non-diabetic patients.

Adverse Prognosis of Peripheral Artery Disease Treatments Associated With Diabetes: A Comprehensive Meta-Analysis

“…Eight studies discussed primary patency (n = 3230). 13,17,20,25,27-30 Among the 8 studies, 4 showed a significantly positive relationship between DM and poor primary patency. However, the RR varied widely between studies, ranging from 0.37 to 1.19.…”

“…Our results showed that there was no significant difference in the limb salvage rate between the diabetic and non-diabetic groups (RR: 0.98; 95% CI: 0.91–1.05). 13,17,19,20,23,28,30-32 No clear risk factors were found after subgroup analysis according to the type of treatment following adjustment for confounding factors and the degree of PAD (Table 1).…”

Assessment of the efficacy of endovascular treatment in chronic limb-threatening ischemia in diabetic and non-diabetic patients

“…In the study conducted by Levigne et al [21], it was found that there were higher amputation rates after endovascular interventions in the diabetic patient group, which was associated with hyperglycemia, reducing the tolerance of tissue ischemia. Xiao et al [22] conducted a study and evaluated the effectiveness of endovascular treatment in limb-threatening leg ischemia, and reported that there were no differences between the diabetic and non-diabetic patient groups in terms of 12-month primary and secondary patency and limb recovery rates. In the literature, up to 70% amputation rates were reported in limb-threatening leg ischemia patients, which were 5 times more common in diabetic patients [23,24].…”