A strong association exists between diabetes mellitus and critical limb ischemia.
Methods and Results:
We performed endovascular therapy on 1060 limbs in 884 patients with below knee lesions only. The patients were divided into diabetes (DG) and nondiabetes groups (NDG). Limb salvage was poorer in the DG (79% vs 89%, P = .0061). No significant difference was observed in mortality, amputation-free survival (AFS), and target vessel revascularization (TVR). Multivariate analysis revealed diabetes status, infection, poor activity of daily living (ADL), younger age, and procedure failure as independent predictors of major amputation in DG. In the NDG, procedure failure was the predictor, and younger age and poor ADL showed tendency of major amputation.
Conclusions:
Mortality, AFS, and TVR showed no significant difference between the 2 groups, but major amputation was more frequent in DG. Not only revascularization but also infection and diabetes control were very important for limb salvage in DG.
CamafortMAlvarez-RodriguesHMunoz-TorrerotJF, et al.Glucose control and outcome in patients with stable diabetes and previous coronary, cerebrovascular or peripheral artery disease. finding from the FRENA registry. Diabet Med. 2011;28:73–80.
2.
ShawJESicreeRAZimmetPZ. Global estimates of prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87:4–14.
3.
NorgrenLHiattWRDormandyJA, et al.Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33:S1–75.
4.
FagliaEPaolaLDClericiGClerissiJGraziani, et al.Peripheral angioplasty as the first-choice revascularization procedure in diabetic patients with critical limb ischemia: prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003. J Vacs Endovasc Surg. 2005;29:620–27.
5.
ChantelauELeeKMJungblutR. Association of below-knee atherosclerosis to medial arterial calcification in diabetes mellitus. Diabetes Res Clin Pract. 1995;29:169–72.
6.
UtsunomiyaMNakamuraMNakanishiM, et al.Impact of wound blush as an angiographic end point of endovascular therapy for patients with critical limb ischemia. J Vasc Surg. 2012;55:113–21.
7.
SchmidtAUlrichMWinklerB, et al.Angiographic patency and clinical outcome after balloon-angioplasty for extensive infrapopliteal artery disease. Catheter Cardiovasc Interv. 2010;76:1047–54.
8.
DormandyJARutherfordRB. Management of peripheral arterial disease (PAD). TASC working group. Transatlantic inter-society consensus (TASC). J Vasc Surg. 2000;31:S1–296.
9.
AdamDJBeardJDClevelandT, et al.Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005;366:1925–34.
10.
BradburyAWAdamDJBellJ, et al.Bypass versus angioplasty in severe ischaemia of the leg (BASIL) trial: analysis of amputation free and overall survival by treatment received. J Vasc Surg. 2010;51:18S–31S.
11.
RowsVLLeeWWeaverFAEtzioniD. Patterns of treatment for peripheral arterial disease in the United States: 1996-2005. J Vasc Surg. 2009;49:910–17.
12.
TakaharaMKanetoHIidaO, et al.The influence of glycemic control on the prognosis of Japanese patients undergoing percutaneous transluminal angioplasty for critical limb ischemia. Diabetes Care. 2010;33:2538–42.
13.
CastronuovoJJJrAderaHMSmiellJMPriceRM. Skin perfusion pressure measurement is valuable in the diagnosis of critical limb ischemia. J Vasc Surg. 1997;26:629–37.
14.
IidaOSogaYHiranoK, et al.Long-term results of direct and indirect endovascular revascularization based on the angiosome concept in patients with critical limb ischemia presenting with isolated below-the-knee lesions. J Vasc Surg. 2012;55:363–70.E5.
15.
RyuHMKimJSKoYGHongMKJangYJChoiDH. Comparison of clinical outcome of infrapopliteal angioplasty between Korean diabetic and non-diabetic patients with critical limb ischemia. Circ J. 2012;76:335–41.
16.
SogaYIidaOHiranoK, et al.Impact of cilostazol after endovascular treatment for infrainguinal disease in patients with critical limb ischemia. J Vasc Surg. 2011;54:1659–67.
17.
KomaiHObitsuYShigematsuH. Diabetes and old age affect long-term patency of paramalleolar distal bypass for peripheral arterial disease in Japanese patients. Circ J. 2011;75:2460–4.
18.
FeiringAJKrahnMNelsonLWesolowskiAEastwoodDSzaboA. Preventing leg amputations in critical limb ischemia with below-the-knee drug-eluting stents: title and subtitle break the paradise (PReventing Amputations using Drug eluting StEnts) trial. J Am Coll Cardiol. 2010;55:1580–89.
19.
ScheinertDKatsanosKZellerT, et al.A prospective randomized multicenter comparison of balloon angioplasty and infrapopliteal stenting with the sirolimus-eluting stent in patients with ischemic peripheral arterial disease 1-year results from the ACHILLES trial. J Am Coll Cardiol. 2012;60:2290–95.
20.
SchmidtAPiorkowskiMWernerM, et al.First experience with drug-eluting balloons in infrapopliteal arteries. J Am Coll Cardiol. 2011;58:1105–9.
21.
ChanKELazarusLMThadhaniRHakimRM. Warfarin use associates with increase risk for stroke in hemodialysis patients with atrial fibrillation. J Am Soc Nephrol. 2009;20:2223–33.
