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Reduced primary patency rate in diabetic patients after percutaneous intervention results from more frequent
Brian G DeRubertis1, Matthew Pierce, Evan J Ryer
1Division of Vascular Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University and Columbia University College of Physicians and Surgeons, 525 E. 68th Street, New York, NY 10021, USA.
Insights
Patients with diabetes have lower primary patency after lower extremity percutaneous interventions for peripheral vascular disease. However, secondary patency and limb salvage rates remain equivalent to non-diabetics, indicating endovascular therapy is suitable.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Diabetic Complications
Background:
- Peripheral vascular disease (PVD) poses a significant amputation risk for diabetic patients.
- Surgical revascularization offers good limb salvage, but outcomes of percutaneous interventions in diabetics are less clear.
- Percutaneous lower extremity revascularization is increasingly used for PVD.
Purpose of the Study:
- To compare outcomes of percutaneous lower extremity revascularization between diabetic and non-diabetic patients.
- To assess differential patency and limb salvage rates in these groups.
- To identify factors influencing outcomes in patients undergoing endovascular treatment for PVD.
Main Methods:
- Retrospective study of 291 patients undergoing percutaneous interventions for PVD (2002-2005).
- Assessment of tibial vessel run-off by angiography and patency by arterial duplex.
- Kaplan-Meier method and log-rank analysis used for patency evaluation with a mean follow-up of 11.6 months.
Main Results:
- Diabetics (57.2%) were more likely to be female and have chronic renal insufficiency and less tibial outflow.
- Primary patency at 1 year was lower in diabetics (53% vs. 71% for non-diabetics, P=.05).
- Secondary patency and 1-year limb salvage rates were similar between diabetics and non-diabetics (88.3% for limb-threatening ischemia).
Conclusions:
- Diabetic patients exhibit reduced primary patency after percutaneous treatment for lower extremity occlusive disease, often due to advanced disease at presentation.
- Despite higher reintervention rates, diabetics achieve comparable short-term secondary patency and limb salvage.
- Patient characteristics associated with reduced primary patency should not contraindicate endovascular therapy.
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
Conclusion:
Patients with diabetes demonstrate reduced primary patency rates after percutaneous treatment of lower extremity occlusive disease, most likely due to their advanced stage of disease at presentation. However, despite a higher reintervention rate, diabetics and others with risk factors predictive of reduced primary patency can attain equivalent short-term secondary patency and limb-salvage rates. Therefore, these patient characteristics should not be considered contraindications to endovascular therapy.
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