Long-term prognosis of diabetic patients with critical limb ischemia after endovascular therapy

Abstract

Introduction. Critical limb ischemia (CLI) occurs approximately 20 times more frequently among diabetic patients. Frequency of amputations is higher too. Main treatment goal in these situations is in reconstruction of arterial blood flow with bypass surgery or endovascular interventions. Nevertheless, long-term prognosis of survival, limb preservation and life quality among Russian patients that underwent this therapy remains unclear, as well as influencing risk factors.The aim of the study was to evaluate the long-term prognosis in diabetic patients with critical limb ischemia (CLI) after peripheral angioplasty with active and nonactive follow-up period.Methods. 81 diabetic patients with CLI underwent PTA in 88 limbs. Patients were divided into 2 groups: group A (n = 51) – with active follow up (FU) period (visits every 3-6 months during 5 years) and group B (n = 30) - without active FU period (the second visit in our center was performed in 5 years after PTA). Diagnosis and treatment of CLI were based on recommendation of TASC II. The primary outcome was cumulative survival, secondary outcome were cases of repeat PTA and major amputations (MA) after 5 years after surgery.Results. Only 44 (86%) patients from group A finished FU period. There were 37 (46%) men, with mean age 64,1[54-68] years, mean HbA1c 7,9±1,4%, mean duration of diabetes 16,5[0,8-43] years, diabetes type 1/2 - 8/73 (90% of type 2). 82% had arterial hypertension, 5% - strokes, 18,5% - myocardial infarction. Chronical kidney disease of stage 1-2 was detected in 55,5%, stage 3-5 – in 30,8%. Anemia was diagnosed in 67,5%, arrhythmias – in 7,4%. 49,3% of patients suffered from diabetic retinopathy. Patients from both groups were comparable in comorbidities, severity of lower limb artery obstruction’s and degree of tissue damage (p<0,05): peripheral arterial disease (PAD) 4-6 classes according Graziani classification in both groups was in 75(93%) cases; Rutherford classification in both groups: 4 category-12(15%), 5category in 43(53%), and 6 category in 29(31%) patients. Repeat PTA was performed in group A in 15 (35%), in group B in 5(16%) cases. There were major amputations in groups: A-4(9%) vs group B – 4(12%) (log-rank, p<0,05). Cumulative survival in groups: A-80%, in group B-67%. (log-rank, p<0,05).Conclusion. CLI in diabetic patients is accompanied by different complications and is characterized by severe morphological lesions of the lower limbs arteries and soft tissue lesions. Active FU period have advantages in diabetic patients with CLI after PTA: timely done reinterventions with decrease the risk of major amputations and cumulative survival.