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Pattern and distribution of peripheral arterial disease in diabetic patients with critical limb ischemia (rutherford
1Vascular Surgery Unit, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Insights
Diabetic patients with critical limb ischemia often have severe tibioperoneal artery disease. Smokers in this group showed more femoropopliteal disease, while females had better foot arch circulation.
Area of Science:
- Vascular Surgery
- Diabetology
- Cardiovascular Medicine
Background:
- Peripheral arterial disease (PAD) is a significant complication in diabetic patients.
- Critical limb ischemia (CLI) in diabetics necessitates understanding disease patterns for effective treatment.
- Risk factor stratification is crucial for predicting PAD severity in diabetic populations.
Purpose of the Study:
- To investigate the pattern and distribution of PAD in diabetic patients with CLI.
- To stratify PAD findings based on risk factors, gender, and age.
- To analyze arterial segment patency and foot arch status variations.
Main Methods:
- A one-year prospective descriptive study was conducted.
- Diabetic patients (age >18) with CLI and vascular imaging were included.
- Arterial patency and foot arch status were analyzed across risk factor groups (including smokers).
Main Results:
- Diabetic patients collectively showed severe tibioperoneal occlusive disease (P < .001).
- Smokers (Group 3) exhibited more severe femoropopliteal disease (P < .001).
- Females were more likely to have complete foot arches compared to males (P = .004).
Conclusions:
- Diabetic patients with CLI predominantly present with severe tibioperoneal occlusive disease.
- Smoking status significantly influences the location of occlusive disease in diabetic CLI patients.
- Female diabetic patients with CLI demonstrate a higher prevalence of complete arterial foot arches.
Background:
This study investigated the pattern and distribution of peripheral arterial disease in diabetic patients with critical limb ischaemia (CLI) and to stratify the findings according to the patients' risk factor profile, gender and age group.
Method:
We conducted a one-year prospective descriptive study (January 2014 to December 2014) at Groote Schuur Hospital, University of Cape Town. The research protocol and the informed consent were approved by the Institutional Review Board, and all subjects included in this study gave an informed consent. We included all diabetic patients over the age of 18 years with critical limb ischemia who had pre and post-intervention vascular imaging. The calculated minimum sample size was 63 limbs. We hypothesize that the proportions of arterial segment patency categories and the arterial foot arch status varies according to gender, age group and risk factor combinations in diabetic patients. The Null hypothesis (N0) assumes that the proportions of arterial segment patency categories and arch status are the same in diabetic patients irrespective of gender, age group and risk factor combination. The equality of distribution was analysed using the One Sample Chi-square test. Three risk factor combination groups were analysed: Group 1 (diabetes mellitus, hypertension, dyslipidemia), Group 2 (diabetes mellitus, hypertension, dyslipidemia, ex-smoker) and Group 3 (diabetes mellitus, hypertension, dyslipidemia, smoker).
Results:
Seventy-one patients were analysed (38 females and 33 males). We recorded the patency grades (ranging from normal to occlusion) of arteries in all 3 lower extremity arterial segments (aortoiliac; femoropopliteal and tibioperoneal segments). Altogether the patency grades of 820 lower extremity arteries were recorded. Diabetics, collectively, were found to have more severe occlusive disease in the tibioperoneal segment (P < .001). Group 3 patients however, had more severe occlusive disease in the femoropopliteal segment compared to the other subgroups (P < .001). Group 1 and Group 2 patients had more severe occlusive disease in the tibioperoneal segment (P < .001). Females were more likely to have complete foot arches (22/37; P = .004) while males tended to have more incomplete foot arches (17/32; P = .048).
Conclusion:
Diabetic patients collectively have severe tibioperoneal occlusive disease. However, Group 3 patients tend to have disproportionately more occlusive disease in the femoropopliteal segment (P < .001). Diabetic female patients with CLI are more likely to have a complete arterial foot arch than males (P = .004).
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