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Recurrence of Critical Limb Ischemia After Endovascular Intervention in Patients with Diabetic Foot Ulcers
Marco Meloni1, Valentina Izzo1, Laura Giurato1
1Department of Systems Medicine, University of Tor Vergata, Rome, Italy.
Insights
Clinical recurrence of critical limb ischemia (CLI) in diabetic patients after angioplasty is common, leading to poor outcomes. Impaired glycemic control and dialysis are key predictors of CLI relapse.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Diabetic Limb Complications
Background:
- Diabetic foot ulcers (DFUs) are a significant cause of morbidity and mortality.
- Critical limb ischemia (CLI) in diabetic patients poses a challenge for limb salvage.
- Percutaneous transluminal angioplasty (PTA) is a primary endovascular treatment for CLI.
Purpose of the Study:
- To determine the rate of clinical recurrence of CLI in diabetic patients with ischemic DFUs following PTA.
- To identify factors associated with CLI recurrence and the outcomes of patients requiring repeat PTA (rePTA).
- To improve limb salvage rates by understanding predictors of restenosis after endovascular treatment.
Main Methods:
- Retrospective analysis of 304 diabetic patients with ischemic DFUs treated with PTA.
- Evaluation of clinical recurrence requiring rePTA, associated factors, and outcomes.
- Follow-up period of 12.5 ± 6.6 months.
Main Results:
- 24.3% of patients (74/304) required rePTA, with a mean time to rePTA of 3.5 months.
- The rePTA group showed significantly lower healing rates (28.5% vs. 71.9%) and higher rates of ulcer recurrence (20% vs. 10.3%), major amputation (24.3% vs. 4.3%), and death (33.3% vs. 7.9%).
- Independent predictors of CLI recurrence were elevated glycated hemoglobin (HbA1c) and dialysis status.
Conclusions:
- Clinical recurrence of CLI post-PTA is linked to poor outcomes, including non-healing ulcers, major amputations, and mortality.
- Dialysis and suboptimal glycemic control are significant independent predictors of CLI relapse after endovascular treatment.
- Identifying these predictors is crucial for optimizing treatment strategies and improving limb salvage in diabetic patients with CLI.
Abstract:
Objective: To establish the rate of clinical recurrence of critical limb ischemia (CLI) in diabetic patients with ischemic foot ulcers (DFUs) treated by percutaneous transluminal angioplasty (PTA). Approach: The study group was composed of 304 patients with ischemic DFUs treated by PTA. We evaluated the rate of clinical recurrence of CLI requiring a second PTA (repeated PTA [rePTA]), the factors related to CLI relapse, and the outcomes of rePTA patients. The follow-up was 12.5 ± 6.6 months. Results: Seventy-four of 304 patients (24.3%) needed rePTA. The mean time to rePTA was 3.5 ± 0.64 months. rePTA group in comparison with no rePTA group had lower rate of healing (28.5% vs. 71.9% p = 0.0001), higher rate of ulcer recurrence (20% vs. 10.3% p = 0.03), major amputation (24.3% vs. 4.3% p = 0.0005), and death (33.3% vs. 7.9% p = 0.002). Glycated hemoglobin, type A1C (HbA1c; 2.2 [1.9-2.7] p = 0.02) and dialysis (1.5 [1.4-3.6] p = 0.006) were independently associated to clinical recurrence of CLI after PTA. Innovation: To identify the outcomes of patients with clinical recurrence of CLI and the clinical factors involved to reduce the rate of restenosis after endovascular treatment and improve the rate of limb salvage. Conclusions: Clinical recurrence of CLI is associated with a high rate of nonhealing ulcer recurrence, major amputation, and death. Dialysis and impaired glycemic control were independent predictors of CLI relapse after endovascular treatment.
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