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[Results of local thrombolysis with special reference to diabetic metabolism]
H Stiegler1, V Hufen, B Weichenhain
1III. Medizinische Abteilung, Forschergruppe Diabetes, Städtisches Krankenhaus München-Schwabing.
Insights
Diabetes negatively impacts initial success rates for peripheral arterial disease thrombolysis, particularly for thrombotic occlusions. However, long-term outcomes and patency rates are similar between diabetic and non-diabetic patients.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Diabetology
Context:
- Peripheral arterial disease (PAD) affects lower limb circulation.
- Local thrombolysis is a treatment for occlusive vascular disease.
- Diabetes is a significant comorbidity influencing vascular health.
Purpose:
- To evaluate the influence of diabetes on local thrombolysis success rates in PAD stages III and IV.
- To compare primary and long-term outcomes in diabetic versus non-diabetic patients undergoing thrombolysis for PAD.
Summary:
- A study of 145 local thrombolyses in PAD stages III-IV (thrombotic, embolic, and thrombangitis obliterans occlusions) analyzed outcomes based on diabetic status.
- Diabetic patients showed lower primary success rates for thrombotic occlusions and significantly poorer outcomes for occlusions >16 cm, attributed to microangiopathy and poor run-off.
- Despite initial differences, long-term patency rates (79%) and prognostic factors were comparable between diabetic and non-diabetic groups, with 2/3 of diabetic patients achieving long-term patency.
Impact:
- Findings suggest diabetes complicates initial thrombolysis success in PAD but does not preclude favorable long-term patency.
- Highlights the importance of considering diabetic complications like microangiopathy in treatment planning and outcome prediction for PAD.
- Informs clinical decision-making regarding thrombolysis for PAD patients with diabetes.
Abstract:
The influence of diabetes on the primary and long-term success rate after 145 local thrombolyses in peripheral arterial disease stages III and IV was evaluated. 75 patients suffered from thrombotic, 62 patients from embolic occlusions, with eight patients suffering from thrombangitis obliterans. Regarding the localisation of vascular occlusion 0.6% suffered under an occlusion of the iliacal artery, 21% of the femoral artery, 16% of the popliteal artery, 7% of the vessel of the lower limb and 55.4% showed a combined occlusion of the femoral- and popliteal artery and the artery of the lower limb. In cases of embolic occlusions only marginal differences could be observed, while the primary success-rate of thrombotic occlusions showed greater differences between both groups (75% vs. 91%). During the follow-up, no differences between both groups could be established (patency-rate of 79% for both groups). The same applies to the prognostic factors: peripheral run off, length, duration of occlusion and the clinical stage (Fontaine IIb to IV). The remarkable differences between diabetic and non-diabetic patients in cases of occlusions of more than 16 cm (66% vs. 88% in primary and 55% vs. 77% in long-term success) can be explained by the high percentage of diabetic patients with poor run-off and microangiopathy. Regarding the above parameters, primary and long-term results seemed to be less in diabetic patients, even though a long-term patency could be observed in 2/3 of diabetic patients in stages IIb and IV with primary success.