TY - JOUR
T1 - Long-term outcomes of diabetic patients undergoing endovascular infrainguinal interventions
AU - Abularrage, Christopher J.
AU - Conrad, Mark F.
AU - Hackney, Lauren A.
AU - Paruchuri, Vikram
AU - Crawford, Robert S.
AU - Kwolek, Christopher J.
AU - Lamuraglia, Glenn M.
AU - Cambria, Richard P.
PY - 2010/8
Y1 - 2010/8
N2 - Objective: Diabetes mellitus (DM) has traditionally predicted poor outcomes after lower extremity revascularization for peripheral vascular disease (PVD). This study assessed the influence of DM on long-term outcomes of percutaneous transluminal angioplasty, with or without stenting (PTA/stent), in patients with PVD. Methods: From January 2002 to December 2007, 920 patients underwent 1075 PTA/stent procedures. Patients were stratified into DM and non-DM cohorts. Study end points included primary patency (PP), assisted patency (AP), limb salvage, and survival and were evaluated using Kaplan-Meier and Cox regression analyses. Results: There were 533 DM and 542 non-DM limbs. Median follow-up was 34 months. Overall, the 5-year actuarial PP was 42% ± 2.4%, AP was 81% ± 2.0%, limb salvage was 89% ± 1.6%, and survival was 60% ± 2.4%. On univariate analysis, DM vs non-DM was associated with inferior 5-year PP (37% ± 3.4% vs 46% ± 3.3%; P = .009), limb salvage (84% ± 2.6% vs 93% ± 1.8%, P < .0001), and survival (52% ± 3.5% vs 68% ± 3.1%, P = .0001). AP did not differ between DM and non-DM patients (P = .18). In the entire cohort, DM (hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.01-1.54; P = .04), single-vessel peroneal runoff (HR, 1.54; 95% CI, 1.16-2.08; P = .003), and dialysis (HR, 1.59; 95% CI, 1.10-2.33; P = .02) were associated with decreased PP on multivariate analysis. The only variables on multivariate analysis to predict limb loss and death were critical limb ischemia (HR, 9.09; 95% CI, 4.17-20.00; P < . 0001; HR, 2.99; 95% CI, 2.01-4.44; P < .0001, respectively) and dialysis (HR, 2.94; 95% CI, 1.39-5.00; P = .003; HR, 4.24; 95% CI 2.80-6.45; P < .0001, respectively). Conclusions: DM is an independent predictor of decreased long-term primary patency after PTA/stent. Although acceptable assisted patency rates can be achieved with close surveillance and reintervention, long-term limb salvage remains inferior in diabetic patients compared with non-diabetic patients due to a more severe clinical presentation and poor runoff.
AB - Objective: Diabetes mellitus (DM) has traditionally predicted poor outcomes after lower extremity revascularization for peripheral vascular disease (PVD). This study assessed the influence of DM on long-term outcomes of percutaneous transluminal angioplasty, with or without stenting (PTA/stent), in patients with PVD. Methods: From January 2002 to December 2007, 920 patients underwent 1075 PTA/stent procedures. Patients were stratified into DM and non-DM cohorts. Study end points included primary patency (PP), assisted patency (AP), limb salvage, and survival and were evaluated using Kaplan-Meier and Cox regression analyses. Results: There were 533 DM and 542 non-DM limbs. Median follow-up was 34 months. Overall, the 5-year actuarial PP was 42% ± 2.4%, AP was 81% ± 2.0%, limb salvage was 89% ± 1.6%, and survival was 60% ± 2.4%. On univariate analysis, DM vs non-DM was associated with inferior 5-year PP (37% ± 3.4% vs 46% ± 3.3%; P = .009), limb salvage (84% ± 2.6% vs 93% ± 1.8%, P < .0001), and survival (52% ± 3.5% vs 68% ± 3.1%, P = .0001). AP did not differ between DM and non-DM patients (P = .18). In the entire cohort, DM (hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.01-1.54; P = .04), single-vessel peroneal runoff (HR, 1.54; 95% CI, 1.16-2.08; P = .003), and dialysis (HR, 1.59; 95% CI, 1.10-2.33; P = .02) were associated with decreased PP on multivariate analysis. The only variables on multivariate analysis to predict limb loss and death were critical limb ischemia (HR, 9.09; 95% CI, 4.17-20.00; P < . 0001; HR, 2.99; 95% CI, 2.01-4.44; P < .0001, respectively) and dialysis (HR, 2.94; 95% CI, 1.39-5.00; P = .003; HR, 4.24; 95% CI 2.80-6.45; P < .0001, respectively). Conclusions: DM is an independent predictor of decreased long-term primary patency after PTA/stent. Although acceptable assisted patency rates can be achieved with close surveillance and reintervention, long-term limb salvage remains inferior in diabetic patients compared with non-diabetic patients due to a more severe clinical presentation and poor runoff.
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U2 - 10.1016/j.jvs.2010.03.015
DO - 10.1016/j.jvs.2010.03.015
M3 - Article
C2 - 20591601
AN - SCOPUS:77955514049
SN - 0741-5214
VL - 52
SP - 314-322+322.e1-322.e4
JO - Journal of vascular surgery
JF - Journal of vascular surgery
IS - 2
ER -