Major Limb Outcomes Following Lower Extremity Endovascular Revascularization in Patients With and Without Diabetes Mellitus

被引:54
|
作者
Shammas, Andrew N. [1 ]
Jeon-Slaughter, Haekyung [2 ,3 ]
Tsai, Shirling [2 ,3 ]
Khalili, Houman [2 ,3 ]
Ali, Mujtaba [2 ,4 ]
Xu, Hao [2 ]
Rodriguez, Gerardo [5 ]
Cawich, Ian [5 ]
Armstrong, Ehrin J. [6 ]
Brilakis, Emmanouil S. [2 ,3 ]
Banerjee, Subhash [2 ,3 ]
机构
[1] Midwest Cardiovasc Res Fdn, Davenport, IA USA
[2] Univ Texas Southwestern Med Ctr Dallas, Dallas, TX 75390 USA
[3] VA North Texas Healthcare Syst, Dallas, TX USA
[4] Parkland Hosp, Dallas, TX USA
[5] Arkansas Heart Hosp, Little Rock, AR USA
[6] Eastern Colorado Vet Affairs Healthcare Syst, Denver, CO USA
关键词
amputation; balloon angioplasty; diabetes mellitus; mortality; peripheral artery disease; reintervention; stenosis; stent; target lesion revascularization; PERIPHERAL ARTERIAL-DISEASE; NONDIABETIC PATIENTS; ATHERECTOMY; PREVALENCE; COHORT;
D O I
10.1177/1526602817705135
中图分类号
R61 [外科手术学];
学科分类号
摘要
Purpose: To determine whether diabetes mellitus has an independent impact on major limb outcomes at 1 year after endovascular treatment of lower extremity peripheral artery disease (PAD). Methods: The study involved 1906 consecutive patients (mean age 66 years; 1469 men) enrolled in the observational Excellence in Peripheral Artery Disease (XLPAD) registry (ClinicalTrials.gov identifier NCT01904851) between January 2005 and October 2015 after undergoing index endovascular procedures in 2426 limbs for arterial occlusive disease. Patient outcomes included 12-month target limb amputation (above ankle) and target limb revascularization as well as all-cause death. Kaplan-Meier analysis and adjusted Cox proportional hazard models were used for time-to-event analysis of outcomes for the entire study sample as well as for the critical limb ischemia (CLI) and claudication subgroups. Results of the Cox regression models are reported as the hazard ratio (HR) and 95% confidence interval (CI). Results: Diabetics undergoing endovascular procedures had higher rates of comorbid conditions (p<0.001), CLI (p<0.001), heavily calcified lesions (p=0.002), multivessel disease (p=0.030), and fewer infrapopliteal runoff vessels (p<0.001). Regression analysis after adjusting for confounders revealed significantly higher target limb major amputation in diabetics compared with nondiabetics (HR 5.02, 95% CI 1.44 to 17.56, p=0.011). However, repeat revascularization rates were similar. When considering CLI and claudication subgroups, diabetes was associated with a nonsignificant increased risk of 12-month major amputation only for patients presenting with CLI (HR 3.48, 95% CI 0.97 to 12.51, p=0.056). Diabetes was also associated with an increased risk of 12-month all-cause mortality in the overall study sample (HR 4.64, 95% CI 2.01 to 10.70, p<0.001) and in the CLI subgroup (HR 14.15, 95% CI 3.16 to 63.32, p<0.001) but not in the claudication subgroup (HR 1.42, 95% CI 0.45 to 4.54, p=0.552). Conclusion: Diabetes increases the risk of major amputation and all-cause death at 12 months following endovascular revascularization in patients with symptomatic PAD. These risks are especially heightened in patients presenting with CLI.
引用
收藏
页码:376 / 382
页数:7
相关论文
共 50 条
  • [41] Trends in lower extremity surgical and endovascular revascularization in Germany
    Eickmeyer, F.
    Moysidis, T.
    Nowak, T.
    Fifer, B.
    Santosa, F.
    Luther, B.
    Kroeger, K.
    VASA-EUROPEAN JOURNAL OF VASCULAR MEDICINE, 2011, 40 (05) : 398 - 403
  • [42] A Comparison of Outcomes After Lower Extremity Bypass and Repeat Endovascular Intervention Following Failed Previous Endovascular Intervention for Critical Limb Ischemia
    Shannon, Alexander H.
    Mehaffey, J. Hunter
    Cullen, J. Michael
    Upchurch, Gilbert R.
    Robinson, William P., III
    ANGIOLOGY, 2019, 70 (06) : 501 - 505
  • [43] Prevalence of Chronic Renal Insufficiency (CRI) and its Impact on Outcomes of Patients Undergoing Lower Extremity Endovascular Revascularization
    Khan, H.
    Graham, A. R.
    Menezes, A.
    JOURNAL OF VASCULAR SURGERY, 2009, 50 (04) : 970 - 970
  • [44] Lower limb revascularization in octogenarians with diabetes mellitus is safe and preserves function.
    Arora, S
    Pomposelli, F
    Gibbons, G
    Frykberg, R
    Smakowski, P
    Freeman, D
    Campbell, D
    Logerfo, F
    DIABETES, 1997, 46 : 1245 - 1245
  • [45] The Military Extremity Trauma Amputation/Limb Salvage (METALS) Study Outcomes of Amputation Versus Limb Salvage Following Major Lower-Extremity Trauma
    Doukas, William C.
    Hayda, Roman A.
    Frisch, H. Michael
    Andersen, Romney C.
    Mazurek, Michael T.
    Ficke, James R.
    Keeling, John J.
    Pasquina, Paul F.
    Wain, Harold J.
    Carlini, Anthony R.
    MacKenzie, Ellen J.
    JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 2013, 95A (02): : 138 - 145
  • [46] Outcomes for critical limb ischemia are driven by lower extremity revascularization volume, not distance to hospital
    Medhekar, Ankit N.
    Mix, Doran S.
    Aquina, Christopher T.
    Trakimas, Lauren E.
    Noyes, Katia
    Fleming, Fergal J.
    Glocker, Roan J.
    Stoner, Michael C.
    JOURNAL OF VASCULAR SURGERY, 2017, 66 (02) : 476 - +
  • [47] Lesion Localization and Limb Outcomes in Elderly Patients with and Without Type 2 Diabetes Mellitus Who Undergo Atherectomy-Assisted Endovascular Revascularization due to Symptomatic Peripheral Artery Disease
    Katsiki, Niki
    Geiss, Eva
    Giesen, Alexander
    Jehn, Amila
    Rammos, Christos
    Karcher, Jan C.
    Schoefthaler, Christoph
    Korosoglou, Grigorios
    JOURNAL OF CLINICAL MEDICINE, 2024, 13 (21)
  • [48] Limb loss after lower extremity revascularization in patients with renal insufficiency.
    O'Hare, AM
    Sidawy, AN
    Feinglass, J
    Merine, KM
    Daley, J
    Khuri, S
    Henderson, WG
    Johansen, KL
    JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2003, 14 : 263A - 264A
  • [49] Mortality Following Major Lower Extremity Amputation in People with And Without Diabetes in Scotland 2004-2013
    Murgitroyd, E.
    Yao, X.
    Kerssens, J.
    Walker, J.
    Wild, S.
    BRITISH JOURNAL OF SURGERY, 2021, 108
  • [50] Lower-limb Amputations in Patients With Diabetes Mellitus
    Pino, Alejandro E.
    Taghva, Samantha
    Chapman, Cary
    Bowker, John H.
    ORTHOPEDICS, 2011, 34 (12) : 956 - 956