Angioplasty In Diabetic Patients Research Articles

Drug Eluting Balloons versus Standard Balloons in Infrapopliteal Angioplasty in diabetic patients

Drug Eluting Balloons versus Standard Balloons in Infrapopliteal Angioplasty in diabetic patients

Effectiveness of Angioplasty in Treatment of Diabetic Foot Patients with Infragenicular Single Stenosis or Occlusion: A Prospective Study

Background: Diabetes is linked to both microvascular and macrovascular complications, such as retinopathy, nephropathy, and neuropathy (microvascular) and ischemic heart disease, peripheral vascular disease, and cerebrovascular disease (macrovascular), resulting in organ and tissue damage in approximately one third to one half of people with diabetes. Objectives: The aim of the current work was to examine the effectiveness and safety of infragenicular angioplasty in diabetic patients with critical limb ischemia (CLI) due to single stenosis or occlusion. Patients and Methods: The current study was a prospective cohort investigation that recruited diabetic patient with infragenicular CLI with or without supragenicular lesion at Vascular Surgery Department, Aswan University Hospital. The primary endpoint in our study was the primary patency at the end of sixth month of follow-up. Results: This study included 20 patients with age ranged between 42 years and 82 years; the majority of patients were males (75%). Eighteen patients (90%) had immediate success; after six months, 14 patients (70%) remained patent.By the end of the sixth month post-revascularization, 15 patients (75%) had limb salvage, while four out of the remaining patients had rest pain relief (80%). Healing of minor ulcers occurred in 80% of the patients, and healing of tissue after debridement or minor amputation occurred in 60% of the patients. Conclusion: It could be concluded that infragenicular angioplasty exhibited efficacy in the management of CLI due to single stenosis or occlusion in diabetic patients, with acceptable patency rate and safety profile.

Endovascular treatment of calcific lesions of the common femoral artery using atherectomy device associated with scoring balloon angioplasty in diabetic patients with high "major amputation" risk.

To investigate the outcomes of patients with calcific lesions in the common femoral artery undergoing endovascular procedures with atherectomy device and scoring balloon angioplasty combined with treatment of steno-occlusive disease of the remaining arterial districts of the lower limb. Between January 2015 and December 2018, 11 diabetic patients at high risk for "major amputation", with calcific lesions of the common femoral artery and ischemic ulcers requiring endovascular treatment were retrospectively evaluated. Technical success was defined as revascularization of the common femoral artery with a residual stenosis lower than 30%. Primary endpoints were an immediate increase of perilesional transcutaneous oxygen pressure (TCPO2) > 40 mmHg, ulcerative lesions improvement up to healing or skin flaps re-epithelialization after minor amputation, limb rescue with rejected major amputation, and resolution of rest pain if present. The success rate of the revascularization procedures was 100%. No patient underwent surgical conversion. One case of peri-operative bleeding at the brachial access site was observed. There were no cases of arterial dissection or undesired distal embolization. The average baseline value of perilesional TCPO2 was 21.8 ± 9.2 mmHg. The mean TCPO2 value was 57.4 ± 7.2 mmHg three days after the procedure (P < 0.05), and 51.2 ± 9.8 mmHg 15 days after (P < 0.05). Minor amputations were performed in five patients with advanced ulcerative lesions. No major amputations were performed in the follow-up period. At 14 months follow-up, one patient developed new occlusion of the CFA for extension from the external iliac artery and underwent a new endovascular procedure. We observed an overall primary patency rate of 91% and a primary assisted patency rate of 100% in our 18-month follow-up. Endovascular approach for severely calcified atherosclerotic lesions of the common femoral artery seems to represent a valid therapeutic option associated with promising results in terms of clinical outcome and low complication rates.

Below Knee Angioplasty in Diabetic Patients: Predictors of Major Adverse Clinical Outcomes

Abstract Background: Tibial vessel disease (stenoses or occlusions) has a huge variety of outcomes either technical or clinical, which has an impact on the health authorities. Aim of Study: To locate clinical outcome predictors fol-lowing Plain Old Balloon Angioplasty (POBA) in diabetic patients with below knee atherosclerotic lesions causing Chronic Limb Threatening Ischemia (CLTI). Patients and Methods: Over one year, 67 patients (CLTI 100%) underwent infragenicular angioplasty. Our main interest was Major Adverse Clinical Outcome (MACO) of thelimb operated upon at follow-up which was adressed as clinical failure, need for subsequent endovascular or surgical revas-cularization or amputation. Results: Amputation free survival was seen in 88% with CLTI. Sound healing of wounds was achieved in 76% of cases with a mean value of healing timeof 10.7 months. Significant predictors of MACO were technical failure (p-value 0.002) and occlusive lesions (p-value 0.019). Freedom of MACO was achieved in 76.1%. Conclusions: Infragenicular angioplasty is a feasible therapeutic option in diabetic population. Type ofthe lesions in addition to smoking may be predictors of adverse outcome.

Evaluation of Passage Route as Predictor of Outcomes of Tibial Angioplasty in Diabetic Patients

Abstract Background: Diabetes is one of the strongest predictors of Peripheral Arterial Disease (PAD). It is associated with two fold increase of relative risk of PAD. Aim of Study: To evaluate passage route as predictor of outcomes of tibial angioplasty in diabetic patients. Patients and Methods: This prospective study included 67 cases of chronic limb threatening ischemia patients (CLTI 100%) underwentinfra genicular angioplasty. Our main interest was to determine adverse clinical events such as clinical failure, need for redo interventions and/or amputation. Results: Almost 91% of our cases (61/67 patients) had a positive history of hypertension that did not seem to be a significant factor of Major Adverse Clinical Outcome (MACO). Foot lesion i.e. ulcerationmay predict MACO. Intraluminal route was performed in 58 (86.6%) cases and via subintimal route in 9 cases (13.4%). In the patients operated upon via intraluminal route, twelve patients developed MACO. These results were of significant statistical value; p-value; 0.020. Conclusions: Foot lesion i.e. ulceration; the larger the wound size or the volume of tissue loss may predict MACO in addition to successful passage route either transluminal or subintimal route inbelow knee PTA is consideredpredictors of adverse outcome.

Translocator protein 18 kDa ligand alleviates neointimal hyperplasia in the diabetic rat artery injury model via activating PKG

AimsThe proliferation of VSMCs is the pathologic basis for intimal hyperplasia after angioplasty in diabetic patients. Translocator protein (TSPO), located in the outer mitochondrial membrane, has been found to regulate redox intermediate components in cell dysfunction. We hypothesized that TSPO may regulate VSMC proliferation and migration, and be involved in the intimal hyperplasia after angioplasty in diabetes. Materials and methodsCell proliferation was measured by cell counting and MTT assays. Cell migration was measured by Transwell® and scratch-wound assays. TSPO expression in arteries of rats and high glucose-treated A10 cells were detected by immunoblotting and immunofluorescence staining. Neointimal formation of carotid artery was induced by balloon injury in type 2 diabetic rat. Key findingsTSPO expression was increased in the arterial samples from diabetic rats and A10 cells treated with high glucose. Down-regulation of TSPO expression by siRNA decreased the high-glucose-induced VSMC proliferation and migration in A10 cells. This phenomenon could be simulated by using TSPO ligands, PK 11195 and Ro5-4864. cGMP/PKG signals were involved in the TSPO ligand action, since in the presence of cGMP or PKG inhibitor ODQ or KT5823 respectively, the effect of PK 11195 on VSMC proliferation was blocked. Furthermore, PK 11195 significantly inhibited neointimal formation by the inhibition of VSMC proliferation. SignificanceThis study suggests that TSPO inhibition suppresses the proliferation and migration of VSMCs induced by hyperglycemia, consequently, preventing atherosclerosis and restenosis after angioplasty in diabetic conditions. TSPO may be a potential therapeutic target to reduce arterial remodeling induced by angioplasty in diabetes.

Clinical Outcomes after Triple Vessel Angioplasty in Diabetic Patients with Triple Vessel Coronary Artery Disease

Background: This study was intended to evaluate clinical outcomes in diabetic patients who underwent triple vessel angioplasty for treatment of triple vessel coronary artery disease. Methods: This was an observational, single centred study, which included a total of 27 diabetic patients who underwent triple vessel angioplasty at a tertiary care hospital from May 2010 to July 2012. The study describes the clinical profile of the patients and a moderate term clinical follow-up to reassess the symptoms, functional status and left ventricular function by history, electrocardiogram, echocardiogram, and treadmill test. Mortality and morbidity were considered as end-points of the study. Results: Of 27 patients, 18 were males, and 55.6% were hypertensive. 70.4% of patients had normal left ventricular function. Total number lesions were 97 and the total stents implanted were 85. Event-free survival rate was 92.6% at a mean follow-up of 20.3 months. Overall 100% continued success was obtained with triple vessel angioplasty. Conclusion: Triple vessel angioplasty can be applied as favourable therapy as an alternative to surgical revascularization in selected diabetic patients. However, larger studies with long-term follow-up would warrant the effectiveness of triple vessel angioplasty in such patients.

Risk of contrast induced nephropathy in diabetic patients affected by critical limb ischemia and diabetic foot ulcers treated by percutaneous transluminal angioplasty of lower limbs

The aim of this study is to evaluate the risk of contrast induced nephropathy (CIN) in diabetic patients with critical limb ischemia (CLI) and foot ulcers (FUs) treated by percutaneous transluminal angioplasty of lower limbs. The study group was composed of 145 diabetic patients who underwent a limb salvage protocol because of CLI and FUs between 2012 and 2015. All patients received a prophylactic strategy against the administration of contrast medium. Serum creatinine (SCr) levels were evaluated the day of procedure and for 3days after. CIN was considered in case of increase of 25% of SCr in comparison to baseline value or an absolute increase of at least 0.5mg/dl without other interfering factors. CIN occurred in 9% (14/145) of the cases. In the 1-year follow-up SCr returned to baseline values in 10 patients (71 %), 3 patients died (21%), and 1 patient had a major cardiovascular event (7%). No patients required dialysis. The risk was independent of chronic kidney disease stage. The rate of contrast nephropathy in each stage (X=0.27) was as follows: 3/20 (15%) in stage 2; 3/66 (4.6%) in stage 3, 7/51 (13.7%) in stage 4; and 1/8 (12.5%) in stage 5. At the univariate analysis factors predicting this risk were anemia (HR 95% 2.5 [CI 1.8-4.2] P=.039) and heart failure (HR 95% 2.6 [CI 2.1-4.6] P=.038), while any significant variable was found at multivariate analysis. Peripheral percutaneous transluminal angioplasty in diabetic patients with CLI and FUs can be performed with a good safety factor and a low risk of contrast medium toxicity.

Outcomes of Coronary Angioplasty in Diabetic Patients – A Retrospective Study

AbstractAims: We want to study the effect of diabetes Mellitus (DM) on the outcomes in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) comparing those with non diabetics, with reference to gender.Methods: We retrospectively evaluated the consecutive patients undergoing PCI either with acute coronary syndrome (ACS) or chronic stable angina (CSA) in our institute between March 2014 to March 2015. We followed them up to one year for the major cardiovascular events (MACES) and other complications. We compared the rate of events between diabetic and non diabetic patients along with gender subgroups and tested for the significance.Results: In 645 patients undergone PCI in our institute, 326(50.5%) were diabetics, of them 104(31.9%) were females. Patients with diabetes with CAD were older with more incidence of hypertension and kidney derangement than non diabetics. History of CAD and previous procedure are definitely more in diabetics as is multi vessel disease (p=0.02) and LV dysfunction (p=0.003). Total number of patients presenting with complications within one year of PCI is 18(0.02%). Of them 14 are males and 4 are females, 14 were diabetics and 4 were non diabetics. There was no statistical significance in the outcomes between female &amp; males (p=0.7), diabetics females &amp; diabetic males (p=0.48) and non diabetics females &amp; nondiabetic males(p=0.7). Male patients with diabetes had significantly more complications than non diabetic males (p=0.05) but there is no significant difference between diabetic and non diabetic females (p=0.59).Conclusion: Patients with DM undergoing PCI had more complications than non diabetics with significant difference between male diabetics and non diabetic males. This difference is not significant between diabetic and non diabetic females.

Short-and long-term results of balloon angioplasty in diabetic patients with foot purulent-necrotic complications

Short-and long-term results of balloon angioplasty in diabetic patients with foot purulent-necrotic complications

Outcome of Percutaneous Transluminal Angioplasty in Diabetic Patients with Critical Limb Ischaemia

We investigated the clinical outcome of percutaneous transluminal angioplasty (PTA) which has not been fully established in diabetic patients with critical limb Ischaemia (CLI) compared with non-diabetics. A total of 73 limbs of 52 patients (50 limbs of 34 diabetic patients and 23 limbs of 18 non-diabetics) who underwent PTA for CLI (Rutherford-Becker category 4, 5 or 6) were enrolled. Rates of amputation and restenosis, and ankle brachial index (ABI), were assessed before and after PTA during a 36-month follow-up period. Diabetic patients had a higher rate of major amputations after PTA (10 vs. 0%, P<0.05); however, total amputation (12.0 vs. 8.7%, P=0.62) and restenosis rates (4.0 vs. 8.7%, P=0.38) were not significantly different compared with non-diabetic patients. ABI at 3 months after PTA was significantly improved in both diabetic and non-diabetic patients (0.70±0.20 vs. 0.93±0.19, P<0.01 in diabetic patients; 0.69±0.25 vs. 0.92±0.17, P<0.01 in non-diabetics). Improved ABI was maintained for 36 months in both groups and did not show a significant difference (0.88±0.21 vs. 0.89±0.20, P=0.89). Our results, showing that the outcome of PTA in diabetic patients is not inferior to that in non-diabetics, suggest the potential benefit of primary PTA, instead of bypass surgery, for CLI in diabetic patients who are at high risk of perioperative complications.

RE: Percutaneous Angioplasty in Diabetic Patients with Critical Limb Ischemia

Dear Sir, We read the article entitled “Endovascular Revascularization for Patients with Critical Limb Ischemia: Impact on Wound Healing and Long Term Clinical Results in 189 Limbs” by Bae et al. (1), as published in Korean J Radiol (2013;14:430-438), with a great interest. This article may provide a useful guide for radiologists. In the paper, authors made a retrospective study on 189 limbs with critical limb ischemia, which were treated with endovascular revascularization between 2008 and 2010. Analysis was made using the Kaplan-Meier method. In our clinical

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O doente diabético com doença coronária crónica. Como revascularizar?

Diabetes is one of the reasons for major concerns when managing patients with acute or chronic ischemic heart disease. The presence of diabetes poses specific issues with respect to outcome and treatment options, leading to worse prognosis.The role of myocardial revascularization in the management of chronic ischemic heart disease is a matter of debate, largely due to some clinical studies that failed to demonstrate it's superiority.Following the BARI-2D trial, coronary artery bypass surgery has gained some advantage over coronary angioplasty in diabetic patients with multivessel disease. This advantage was recently consolidated in the FREEDOM trial, which showed significantly better outcomes at five year follow up.

Percutaneous Angioplasty in Diabetic Patients with Critical Limb Ischemia and Chronic Kidney Disease

Introduction: Diabetes and Chronic Kidney Disease (CKD) are two strong risk factors for peripheral arterial disease (PAD) and Critical Limb Ischemia (CLI). Further renal insufficiency increases the risk of non healing wounds and major amputation. Primary amputation rates of 22% to 44% have been reported for ischaemic foot lesion in End-Stage Renal Disease (ESRD) patients. In our study we evaluated the outcomes after Percutaneus Transluminal Angioplasty (PTA) in diabetic patient in relation to different CKD classes. Materials and Methods: We studied a group of 456 diabetic patients with PAD complicated by foot lesion who underwent PTA because of a CLI. According to the estimated Glomerular Filtration Rate (eGFR mL/min/1.73 m2) we divided the patients into five CKD groups: group 1 eGFR > 90, group 2 eGFR 90 - 60 (n = 160), group 3 eGFR 60 - 30 (n = 152), group 4 eGFR 30 -15 (n = 34) and group 5 Results: Alive without major amputation, alive with major amputation and death were respectively: for group 1 (77.8%, 11.1%, 11.1%), for group 2 (74.4%, 12.5%, 13.1%), for group 3 (80.3%, 11.2%, 8.5%), for group 4 (82.3%, 8.8%, 8.8%). They were 60%, 18.3%, 21.7% for group 5 significantly different from the other CKD groups (χ2 = 0.0175). Our analysis did not highlight any relationship between eGFR and outcomes and eGFR did not show any significant difference according to the different outcomes, and were respectively 60.2 ± 1.3, 61.8 ± 3.4, 63.8 ± 3.5 (P = ns). Conclusion: The outcomes were similar for groups 1-4 and therefore, according to our data, they seemed not to be influenced by the decline of GFR. Outcomes worse significantly in group 5, but this group included only patients with ESRD in dialysis treatment. Although the outcomes after PTA in group 5 was significantly worse than the other groups, still a 60% limb salvage rate was obtained with PTA also in these very fragile patients. PTA was much less aggressive than by-pass and PTA was the only method used to treat CLI in our patients. This could explain why we recorded similar outcomes in all groups despite the decline of GFR that, generally speaking, mirrors a worsening of the general clinical conditions. Worse outcomes were recorded only in group 5 and in this group dialysis by itself might be responsible of the different outcomes.

C-reactive protein as an outcome predictor for percutaneous transluminal angioplasty in diabetic patients with peripheral arterial disease and infected foot ulcers

Aim Although percutaneous transluminal angioplasty (PTA) is an effective therapeutic procedure for critical limb ischemia, several clinical factors can influence the outcome of PTA for peripheral arterial disease (PAD). The aim of this study is to identify the outcome predictors of PTA in infected diabetic foot patients with PAD. Methods Eighty-five diabetic patients with a total of 90 infected limbs treated by PTA participated in this study. Patients were initially admitted for infected foot ulcers and were later diagnosed with PAD. Even though all patients underwent successful PTA within 15 days of admission, limb salvage was successful in 66 cases while 24 underwent subsequent amputation. The clinical characteristics and laboratory variables of both groups before PTA were compared and analyzed. Results Significantly higher level of C-reactive protein (CRP) was observed in the major amputation group before PTA. The cutoff value via receiver operating characteristic curve was 50 mg/L (81.8% specificity, 70.7% sensitivity). Multivariate logistic regression analysis revealed that CRP levels may serve as valuable marker in determining a successful outcome. Conclusion Reduced CRP levels (<50 mg/L), which indicates a low infection severity, may serve as a major predictor of successful PTA outcome in diabetic patients with infected foot ulcers.

Primary Infrainguinal Subintimal Angioplasty in Diabetic Patients

The aim of this study was to prospectively evaluate technical and clinical results of infrainguinal subintimal angioplasty in a series of diabetic patients with limb-threatening ischemia. From July 2003 to December 2007, 60 consecutive diabetic patients (M/F = 41/19; mean age, 69.4 +/- 9.4 years) with Fontaine stage IV critical limb ischemia, not suitable for surgical recanalization, underwent primary infrainguinal subintimal angioplasty. The technical success, perioperative morbidity and mortality, and clinical success (defined by ulcer healing) were evaluated. Kaplan-Meier life-table analysis was obtained for cumulative clinical success, limb salvage, and survival rates. The procedure was technically successful in 55 of 60 (91.7%) patients; in 5 cases we were not able to achieve a reentry. Periprocedural mortality was 5% (3 patients); three patients (5%) required major amputation periprocedurally. Mean follow-up was 23 months (range, 0-48 months). On an intention-to-treat basis, the limb salvage rate was 93.3% (56/60 patients); ulcer healing was observed in 45 of 60 (75%) patients and it was significantly (p < 0.05) associated with serum creatinine and HbA1c levels, diabetes duration, and infrapopliteal recanalization. One- and three-year cumulative survival rates were 91.5% and 83.1%, respectively; serum creatinine levels, patient age, and clinical success were significant predictors of survival. In conclusion, infrainguinal primary subintimal angioplasty is a safe and effective treatment in diabetic patients with limb-threatening ischemia not suitable for surgical recanalization. This procedure is aimed to create a "temporary bypass" that facilitates ulcer healing.

Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Patients with Diabetes Mellitus

Reduction of restenosis and reinterventions was recently reported with percutaneous interventions (PCI) with drug-eluting stents (Cypher). This study compares results of Cypher (Cordis, Miami Lakes, FL) stenting and surgical revascularization in diabetic patients. From January 2002 to January 2005, 518 consecutive diabetic patients underwent myocardial revascularization; 176 by PCI incorporating Cyphers and 342 treated surgically. Single-vessel patients in the surgical group were treated with the left internal thoracic artery (ITA) and most multivessel patients were treated with two ITAs. After matching for age, sex, right system revascularization, and extent of coronary disease, two groups (86 patients each) were used to compare the two revascularization modalities. Both groups were similar; however, left main, poor ejection fraction, total occlusion, and bifurcation lesions were more prevalent in the surgical group, and in-stent restenosis in the PCI group. The mean number of coronary vessels treated was higher in the surgical group (2.05 vs 1.6, p < 0.001). Mean follow-up was 18 months. Overall mortality (early and late) was 2.3% and 3.5% in the Cypher and surgical groups, respectively (p = 0.65). Angina returned in 39.5% of the Cypher group and 15.1% of the surgical group, p < 0.001. There were 25 reinterventions in the Cypher group compared with five in the surgical group (p = 0.010). The Cox proportional hazard model revealed assignment to the Cypher group to be the only independent predictor of reangina (odds ratio [OR] 3.26, 95% confidence interval [CI] 1.63 to 6.53) and reintervention (OR 4.17, 95% CI 1.92 to 20.83). Despite improved results of PCI with Cyphers, midterm clinical outcome of diabetic patients treated surgically is better.

Comparison of frequency of insulin resistance after coronary stenting in patients with type 2 diabetes mellitus with versus without coronary restenosis

The large incidence of restenosis after coronary angioplasty in diabetic patients renders this procedure less effective than in nondiabetics, and insulin resistance could be a relevant cause of restenosis in such patients. This study assessed insulin resistance and biologic markers of metabolic control in type 2 diabetic patients treated with stented angioplasty. Seventy-four patients were studied prospectively. Biochemical determinations, insulin tolerance test results, and the rate constant for plasma glucose disappearance (K(itt)%) were obtained. The angiographic outcome of angioplasty was assessed by quantitative coronary analysis at baseline and at 6 months in 64 patients (86%). Patients with restenosis had smaller minimum luminal diameters after stenting (2.8 +/- 0.5 vs 3.04 +/- 0.5 mm, p = 0.05), were more often hypertensive (97% vs 79%, p = 0.02) and treated with angiotensin-converting enzyme inhibitors (53% vs 23%, p = 0.02), and had smaller K(itt)% (2.9 +/- 1.6%/min vs 3.7 +/- 1.4%/min, p = 0.04) and larger titers of growth hormone (1.36 +/- 1.5 vs 0.68 +/- 0.6 ng/ml, p = 0.02).

Clinical outcome of primary infrainguinal subintimal angioplasty in diabetic patients with critical lower limb ischemia.

To evaluate the clinical outcome of subintimal angioplasty in diabetic patients with critical limb ischemia (CLI) compared to nondiabetics irrespective of the patency status of the treated arteries. The records of 99 consecutive patients (53 men; median age 78.5 years, range 42-92) suffering from CLI who underwent primary infrainguinal subintimal angioplasty in 112 limbs within a 6-month period were studied retrospectively. A third of the patients (n=33) were diabetic. The technical success, perioperative morbidity/mortality, and clinical success were compared between the diabetic and nondiabetic patients. Kaplan-Meier life-table analysis was used to analyze clinical success, limb salvage, and survival for both groups. The overall technical success was 89% (81% in diabetics, 93% in nondiabetics, p=0.05). Perioperative morbidity was 8% (16.7% in diabetics, 3.9% in nondiabetics, p=0.03). The perioperative mortality was zero. The clinical success at 12, 24, and 36 months was 74%, 72%, and 65% in nondiabetics and 69%, 63%, and 54% in diabetics, respectively (p=0.17). The limb salvage rate at 36 months was 88% overall (90% in nondiabetics, 82% among diabetics, p=0.20). The 36-month survival rate was 61% in nondiabetics and 57% in diabetics (p=0.29). In terms of clinical outcome, infrainguinal subintimal angioplasty is almost equally effective in diabetics as in nondiabetics suffering from CLI.