| Long-term outcomes of diabetic patients undergoing endovascular infrainguinal interventions. | |
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MedLine Citation:
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PMID: 20591601 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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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Authors:
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Christopher J Abularrage; Mark F Conrad; Lauren A Hackney; Vikram Paruchuri; Robert S Crawford; Christopher J Kwolek; Glenn M LaMuraglia; Richard P Cambria |
Publication Detail:
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Type: Comparative Study; Journal Article Date: 2010-06-29 |
Journal Detail:
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Title: Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter Volume: 52 ISSN: 1097-6809 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-07-30 Completed Date: 2010-08-31 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 314-22.e1-4 Citation Subset: IM |
Copyright Information:
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Copyright (c) 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Division of Vascular and Endovascular Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Amputation Angioplasty, Balloon* / adverse effects, instrumentation Ankle Brachial Index Arterial Occlusive Diseases / complications, mortality, physiopathology, therapy* Boston Chi-Square Distribution Diabetes Complications / mortality, physiopathology, therapy* Female Humans Kaplan-Meiers Estimate Limb Salvage Male Proportional Hazards Models Retrospective Studies Risk Assessment Risk Factors Stents Time Factors Treatment Outcome Vascular Patency Vascular Surgical Procedures |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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