Endovascular Treatment for Critical Limb Ischemia in Type II Diabetes Mellitus Involving Femoropopliteal and
Nabil A Al-Zoubi1, Nawaf J Shatnawi1, Lujain Bakkar1
1Department of Surgery, Vascular Surgery, Jordan University of Science and Technology, Irbid, 22110, Jordan.
Insights
Adding infrapopliteal angioplasty to femoropopliteal revascularization significantly reduces major amputation rates in diabetic patients with critical lower limb ischemia (CLI). Secondary interventions and mortality did not differ significantly between groups.
Area of Science:
- Vascular Surgery
- Diabetic Complications
- Endovascular Interventions
Background:
- Critical lower limb ischemia (CLI) poses a significant risk of amputation and mortality in diabetic patients.
- Femoropopliteal revascularization is a standard treatment, but infrapopliteal disease progression often complicates outcomes.
- Optimizing endovascular strategies for diabetic CLI patients is crucial for limb salvage.
Purpose of the Study:
- To evaluate the impact of combined femoropopliteal and infrapopliteal endovascular angioplasty on major amputation rates, secondary interventions, and mortality.
- To compare outcomes in diabetic patients with CLI treated with femoropopliteal revascularization alone versus combined femoropopliteal and infrapopliteal treatment.
- To identify the optimal endovascular approach for improving clinical outcomes in this high-risk population.
Main Methods:
- Retrospective analysis of 90 type-II diabetic patients with CLI undergoing endovascular treatment between October 2015 and September 2019.
- Patients were divided into two groups: Group I (femoropopliteal segment treatment only) and Group II (femoropopliteal and infrapopliteal segment treatment).
- Outcomes assessed included major amputation rate, secondary intervention rate, and mortality, with analysis of demographic and risk factor data.
Main Results:
- The combined treatment group (Group II) demonstrated a significantly lower major amputation rate (17.4%) compared to the femoropopliteal only group (Group I) (38.6%, p=0.034).
- No statistically significant differences were observed in the rates of secondary interventions (39.1% vs 56.8%, p=0.139) or mortality (28.3% vs 22.7%, p=0.632) between the two groups.
- The study included 90 patients, with 46 in Group II and 44 in Group I, with comparable mean ages.
Conclusions:
- Endovascular infrapopliteal angioplasty combined with femoropopliteal revascularization significantly improves clinical outcomes by reducing major amputation rates in diabetic patients with CLI.
- While limb salvage is enhanced, the addition of infrapopliteal angioplasty did not significantly alter the need for secondary interventions or overall mortality.
- These findings support the consideration of comprehensive infrapopliteal endovascular treatment in diabetic patients with CLI to prevent major amputations.
Purpose:
To determine if further endovascular infrapopliteal angioplasty in combination with femoropopliteal revascularization improves the clinical outcomes regarding major amputation rate, rate of secondary interventions, and mortality in diabetic type-II patients presented with critical lower limb ischemia (CLI).
Patients And Methods:
This is a retrospective study in which all type-II diabetic patients with CLI at King Abdullah University Hospital between October 2015 and September 2019 were identified. Patients with concomitant femoropopliteal and infrapopliteal vessels atherosclerotic lesions (total occlusion or more than 50% stenosis) who received successful endovascular treatment were included. Patients were divided into 2 groups. Group-I included patients treated for femoropopliteal segment alone, while Group-II included patients treated for both femoropopliteal and infrapopliteal segments. The outcomes of the two groups were compared regarding major amputation rate, rate of secondary interventions, and mortality. In addition, demographic data, atherosclerotic lesions distributions and cardiovascular risk factors were also collected and analyzed.
Results:
In all, 90 patients (65 males and 25 females) with a mean age of 67.5±12 years were included. In Group-I; 44 patients (48.9%) were included (36 males and 8 females) with a mean age of 67±12 years. In group-II; 46 patients (51.1%) were included (29 males and 17 females) with a mean age of 68±13 years. The major amputation rate was higher and statistically significant in Group-I (38.6% vs 17.4%, p-value = 0.034). However, the secondary interventions and the mortality rates showed no statistically significant differences (56.8% vs 39.1%, p-value = 0.139) and (22.7% vs 28.3%, p-value = 0.632), respectively.
Conclusion:
Endovascular infrapopliteal angioplasty in combination with femoropopliteal revascularization in diabetic type-II patients with CLI improves the clinical outcome regarding major amputation rate. However, there were no significant differences regarding the rate of secondary interventions and the mortality rate.
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