Long‐term outcomes of patients with diabetes mellitus undergoing percutaneous intervention for popliteal and infrapopliteal peripheral arterial disease

Neupane, Saroj; Edla, Sushruth; Maidona, Eesha; Sweet, Matthew C.; Szpunar, Susan; Davis, Thomas P.; LaLonde, Thomas; Mehta, Rajendra H.; Rosman, Howard; Yamasaki, Hiroshi

doi:10.1002/ccd.27571

Cited by 19 publications

(25 citation statements)

References 26 publications

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“…Increased HbA1c was associated with increased rates of major amputation during a median follow-up of 3.8 years, whereas total mortality was not assessed. 25 In the study of Neupane et al , 4 on the other hand, HbA1c levels were related to neither mortality nor major amputation, and there was no difference in outcome between insulin- and non-insulin-requiring patients. Potential relationships between microvascular diabetic complications and events 26 , 27 in the group with DM have not been evaluated in the present study.…”

Section: Discussionmentioning

confidence: 91%

“…The retrospective single-centre study by Neupane et al evaluated outcomes of 714 patients undergoing popliteal and infrapopliteal endovascular surgery for CLTI or IC. 4 During the median 3 years of follow-up, patients with DM showed higher rates of both all-cause mortality and major amputation.…”

Section: Discussionmentioning

confidence: 97%

“…The strong associations between DM and the development of both infrainguinal PAD 4 and other forms of CVD are due to the pro-atherogenic effects of the diabetic state. 5 , 6 By increasing vascular inflammation and dyslipidaemia, and by leading to an overproduction of advanced glycation end-products, DM causes increased endothelial dysfunction.…”

Section: Introductionmentioning

confidence: 99%

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Worse cardiovascular prognosis after endovascular surgery for intermittent claudication caused by infrainguinal atherosclerotic disease in patients with diabetes

Dakhel

Zarrouk

Ekelund³

et al. 2020

Therapeutic Advances in Endocrinology

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Background: Diabetes mellitus (DM) is an established risk factor for intermittent claudication (IC) and other manifestations of atherosclerotic peripheral arterial disease. Indications for surgery in infrainguinal IC are debated, and there are conflicting reports regarding its outcomes in patients with DM. Aims of this study were to compare both short- and long-term effects on total- and cardiovascular (CV) mortality, major adverse cardiovascular events (MACEs), acute myocardial infarction (AMI), stroke, and major amputation following infrainguinal endovascular surgery for IC in patients with and without DM. We also evaluated potential relationships between diabetic control and outcomes in patients with DM. Methods: Nationwide observational cohort study of patients registered in the Swedish Vascular Registry and the Swedish National Diabetes Registry. Propensity score adjusted comparison of total and CV mortality, MACE, AMI, stroke, and major amputation after elective infrainguinal endovascular surgery for IC in 626 patients with and 1112 without DM at 30 postoperative days and after median 5.2 [interquartile range (IQR) 4.2–6.3] years of follow-up for patients with DM, and 5.4 (IQR 4.3–6.5) years for those without. Results: In propensity score adjusted Cox regression after 30 postoperative days, there were no differences between groups in morbidity or mortality. At last follow-up, patients with DM showed higher rates of MACE [hazard ratio (HR) 1.26, confidence interval (CI) 1.07–1.48; p < 0.01], AMI (HR 1.48, CI 1.09–2.00; p = 0.01), and major amputation (HR 2.31, CI 1.24–4.32; p < 0.01). Among patients with DM, higher HbA1c was associated with higher total mortality during follow-up (HR 1.01, CI 1.00–1.03; p = 0.045). Conclusion: Patients with DM have higher rates of MACE, AMI, and major amputation in propensity score adjusted analysis during 5 years of follow-up after infrainguinal endovascular surgery for IC. Furthermore, HbA1c is associated with total mortality in patients with DM. Prevention and treatment of DM is important to improve cardiovascular and limb outcomes.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Worse cardiovascular prognosis after endovascular surgery for intermittent claudication caused by infrainguinal atherosclerotic disease in patients with diabetes

Dakhel

Zarrouk

Ekelund³

et al. 2020

Therapeutic Advances in Endocrinology

View full text Add to dashboard Cite

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“…In Neupane et al (2016) who conducted a study to evaluate the clinical, angiographic characteristics and outcomes of patients with popliteal and infrapopliteal peripheral arterial disease (PAD) undergoing peripheral vascular intervention (PVI) , the smokers percentage was (66.5%), hypertension was present in (95%) of patients, diabetes mellitus in (65%) of patients, (16.7%) of patients with end stage renal disease (ESRD) on regular dialysis, ischemic heart disease (IHD) in (74.6%)of patients, and previous stroke in (26%) of patients [16].…”

Section: Mahmoud M; Et Al… -464-mentioning

confidence: 99%

Comparative Study Between Infragenicular Balloon Angioplasty and Conservative Management in Treatment of Patients With Critical Lower Limb Ischemia

2018

Zagazig University Medical Journal

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Background: Critical limb ischemia (CLI) is a severe degree of peripheral arterial occlusive disease (PAD) that requires rapid intervention to avoid limb loss and its associated mortality and morbidity .The mainstay of treating of a patient with critical limb ischemia is to reperfuse his limb which can be achieved by direct revascularization by surgical interference or endovascular management or indirect revascularization through other conservative measures as medical therapy, spinal cord stimulation and hyperbaric oxygen. This study aims to compare between the outcomes of endovascular intervention and conservative management of patients with critical limb ischemia. Subjects & methods: The study included 76 patients with critical limb ischemia CLI, 38 patients were treated by endovascular intervention and the other 38 patients were conservatively. Results: Results proved that revascularization of critical limb ischemia patients by endovascular intervention was better than conservative management in terms of limb salvagability and patient survival. Conclusion: Endovascular intervention was found to be a promising and more effective procedure than conservative management in patients with critical limb ischemia and the conservative procedure should be limited to patients not feasible to revascularization.

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“…Approximately 5% of adult Americans suffer from lower extremity arterial disease (LEAD), and one‐tenth of these patients are found to have critical limb ischemia (CLI) . The main risk factors for PAD include age, smoking, diabetes, hypertension, and hypercholesterolemia . According to previous studies, PAD symptoms, such as claudication, cramps, or numbness, cause a significant decrease in life quality .…”

Section: Introductionmentioning

confidence: 99%

Clinical significance of mirror lesions in lower extremity arterial disease

Kiesz

Góra

Kolarczyk-Haczyk

et al. 2019

Cathet Cardio Intervent

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Objective: The aim of this study was to investigate the clinical relevance of bilateral peripheral arterial disease (PAD) patterns.Background: No prior study has evaluated the clinical significance of symmetrical lesion patterns, particularly the coexistence of same-level significant plaques in both lower extremities ("mirror lesions"). Methods:We conducted a single-facility, primary data analysis involving 225 patients with symptomatic PAD.Results: Eighty-two percent of the patients had bilateral lesions: 14.2% had femoropopliteal, 38.7% had infrapopliteal, and 27.1% had both femoropopliteal and infrapopliteal lesions. The lesions were found in the exact same arteries bilaterally in 24.9% of the patients, while 26.7% had a local mirror pattern limited to the femoropopliteal (13.7%) or infrapopliteal (12.9%) arteries.Having a lesion in an artery was a risk factor for occlusive disease of the corresponding artery on the other side. Patients presenting with critical limb ischemia (CLI) had a history of resting pain (17%), ulceration/gangrene (13%), or prior amputation (26%) of the contralateral limb. Patients with significant bilateral disease had unilateral falsenegative ABI results in 11.6% of the cases. The arterial Doppler study results were unilaterally false-negative in 19.6% and bilaterally false-negative in 2.8% of the patients.Conclusions: Patients with known peripheral arterial disease need to have both limbs fully evaluated and monitored, even in cases with negative screening results. Mirror angiographic imaging is common and often accompanied by symptoms of claudication. Unilateral ischemia is a strong risk factor for contralateral disease. Patients with CLI are at high risk for occlusive lesions of the nonindex limb. K E Y W O R D Sankle-brachial index, critical limb ischemia, duplex Doppler ultrasonography, fluoroscopic angiography, peripheral arterial disease

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Long‐term outcomes of patients with diabetes mellitus undergoing percutaneous intervention for popliteal and infrapopliteal peripheral arterial disease

Cited by 19 publications

References 26 publications

Worse cardiovascular prognosis after endovascular surgery for intermittent claudication caused by infrainguinal atherosclerotic disease in patients with diabetes

Worse cardiovascular prognosis after endovascular surgery for intermittent claudication caused by infrainguinal atherosclerotic disease in patients with diabetes

Comparative Study Between Infragenicular Balloon Angioplasty and Conservative Management in Treatment of Patients With Critical Lower Limb Ischemia

Clinical significance of mirror lesions in lower extremity arterial disease

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