Outcome of intra-arterial thrombolysis in patients with diabetes and acute lower limb ischemia: a propensity score adjusted analysis

Abstract

The presence of diabetes mellitus is rarely addressed in acute lower limb ischaemia (ALLI). The aim of this study was to evaluate the outcome of local intra-arterial thrombolysis for ALLI in patients with diabetes mellitus (DM). Outcome of all thrombolytic events performed in an endovascular first-strategy centre during a 13-year period between 2001 and 2013 in patients with ALLI were followed to January 2017. A propensity score adjusted analysis was performed to evaluate results in patients with (n = 83) versus without (n = 316) DM. Patients with DM were younger (p = 0.001), more often women (p = 0.014), more often had renal insufficiency (p = 0.041), foot ulcers (p < 0.001), and thrombosis (p = 0.032) than the patients without DM. At presentation, patients with DM had a lower degree of ischemia judged by the Rutherford classification, compared to those without DM (p = 0.023). None of the 83 diabetic patients had a popliteal artery aneurysm, compared to 25 (7.9%) of the 316 patients without DM (p = 0.008). The amount of tPA administered to patients with DM was higher than to patients without DM (p = 0.03). In the propensity score adjusted analysis, patients with DM had a higher rate of major amputation at 1 (OR 2.52; 95% CI 1.22–5.20) and 3 years (OR 2.52; 95% CI 1.26–5.04), and a lower amputation-free survival at 3 years (OR 0.46; 95% CI 0.25–0.85), than those without DM. Patients with DM presenting with ALLI differ in clinical characteristics, presentation, and aetiology compared to patients with DM, and have a higher rate of major amputation and lower amputation-free survival rate after intra-arterial thrombolysis.

Outcomes of intravenous thrombolytic and adjuvant surgery in acute limb ischemia: Review of 23 patients

“…Thrombectomy and perioperative endovascular aspiration and mechanical thrombectomy are used as surgical treatments. Fast revascularization in ALI is achievable with combined thrombolytic therapy [9,10]. Today, commonly-accepted use of thrombolytic agents is in case of an extremity threatening ischemia.…”

Influence of diabetes on diagnostic performance of computed tomography angiography of the calf arteries in acute limb ischemia

“…On the other hand, the strength of this study is the performance of paired examinations of CTA and initial angiogram within a day in patients with ALI (3). The evaluation of inter-rater reliability in both groups was another strength of the study.…”

“…A large proportion of patients with ALI has diabetes mellitus (DM), 21% in the present population (3). Since it is well-known that patients with DM have a more extensive distal arterial occlusive disease with a high prevalence of long tibial occlusions compared to non-diabetic patients (4), the diagnostic accuracy with CTA in calf artery occlusive disease may be questioned.…”

Wide Spread Arterial and Venous Thrombosis in a Case of Hyperglycemic Hyperosmolar State (HHS)

“…Current guidelines provide for thrombo-prophylaxis in HHS, i.e., LMW Heparin during admission if no major contra-indications exist [10]. This covers the risk for a deep venous thrombosis, but might be insufficient in case of an imminent arterial thrombosis, especially in case of a long existing diabetes [11]. Alternative compounds, targeting crucial factors in the coagulation pathway leading to an arterial thrombus, should be searched for [12].…”