No Association of Diabetic Duration or Insulin Use with the Prognosis of Critical Limb Ischemia after Endovascular Therapy

Takahara, Mitsuyoshi; Kaneto, Hideaki; Iida, Osamu; Katakami, Naoto; Sakamoto, Fumie; Matsuoka, Taka‐aki; Ikeda, Masahiko; Shimomura, Iichiro

doi:10.5551/jat.9951

Cited by 6 publications

(5 citation statements)

References 31 publications

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“…The prevalence of insulin dependency was not of prognostic relevance for mortality. These results of our study are supported by previous trials of Aulivola et al 24 and Takahara et al 24,26…”

Section: Discussionsupporting

confidence: 93%

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Survival of diabetes patients with major amputation is comparable to malignant disease

Hoffmann

Kujath

Flemming

et al. 2015

Diabetes and Vascular Disease Research

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Introduction: Almost all studies on diabetic foot syndrome focused on prevention of amputation and did not investigate long-term prognosis and survival of patients as a primary outcome parameter. Methods:We did a retrospective cohort study including 314 patients who had diabetic foot syndrome and underwent amputation between December 1995 and January 2001. Results: A total of 48% of patients received minor amputation (group I), 15% only major amputation (group II) and 36% initially underwent a minor amputation that was followed by a major amputation (group III). Statistically significant differences were observed in comparison of the median survival of group I to group II (51 vs 40 months; p = 0.016) and of group II to group III (40 vs 55 months; p = 0.003). Discussion: The prognosis of patients with major amputation due to diabetic foot syndrome is comparable to patients with malignant diseases. Vascular interventions did not improve the individual prognosis of patients.

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Section: Discussionsupporting

confidence: 93%

“…These results of our study are supported by previous trials of Aulivola et al 24 and Takahara et al 24,26 One of the mainstays of the therapy of DFS is surgical or interventional revascularization. A study group of Moulik et al was investigating the prognosis of patients with DFS.…”

Section: Discussionsupporting

confidence: 82%

Survival of diabetes patients with major amputation is comparable to malignant disease

Hoffmann

Kujath

Flemming

et al. 2015

Diabetes and Vascular Disease Research

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“…These findings are in contrast with the common knowledge that DM increases the mortality risk in patients with other cardiovascular diseases, including CAD (21) , (22) . We also found that the duration of diabetes was not significantly associated with the risk of major amputation after revascularization in patients with CLTI (23) , whereas the duration of diabetes is often regarded as an important predictor of cardiovascular events (24) , (25) . These findings indicate that CLTI would have different clinical features than other cardiovascular diseases, including CAD, although both are pathologically rooted in atherosclerosis.…”

Section: Clinical Features Of Clti #1: Prognosismentioning

confidence: 61%

Diabetes Mellitus and Lower Extremity Peripheral Artery Disease

Takahara

2021

JMA J

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Lower extremity peripheral artery disease, or often simply called peripheral artery disease (PAD), is a common cardiovascular disease, as coronary artery disease is. Atherosclerotic disease of the arteries of the lower extremity, or arteriosclerosis obliterans, accounts for the vast majority of PAD today. Rest pain, nonhealing ulcers, and gangrenes associated with chronic ischemia (i.e., Fontaine stage III and IV or Rutherford category 4 to 6) are referred to as chronic limb-threatening ischemia (CLTI), formally called critical limb ischemia (CLI). This narrative review focuses on atherosclerotic PAD, especially CLTI, mainly highlighting its link with diabetes mellitus (DM). This article will first overview the clinical impact of DM in patients with symptomatic PAD and that of symptomatic PAD in patients with DM, followed by the clinical features of CLTI, which will be discussed from a viewpoint of its prognosis, patient profile, onset, and seasonality. DM poses a great clinical impact on CLTI, and vice versa. Patient profile appears different between DM patients complicated with CLTI and the general population with DM. Furthermore, although CLTI is pathologically rooted in atherosclerosis as is acute coronary syndrome (ACS), CLTI has considerably different clinical features compared with ACS. CLTI has an extremely poor prognosis even after revascularization, and there is ample room for improvement in terms of its prognosis. Some measures might be needed in healthcare and clinical settings before revascularization: e.g., DM control and regular ischemia risk evaluation before CLTI onset, proper diagnosis at CLTI onset, and prompt referral to a vascular specialist after CLTI onset, although its evidence is still scanty. Piling up evidence of patients with CLTI, by patients with CLTI, and for patients with CLTI is needed.

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“…Based on the primary end point, major amputation after at least 6 months of follow-up, final inclusion resulted in 42 articles. These included studies focusing on antiplatelet therapy, 9-12 antihypertensive medication, 9, 13-16 statins, 9, 17-21 stem cell therapy, [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] growth factors, [38][39][40] prostanoids, [41][42][43][44][45] cilostazol, 46 glucose control, 47 spinal cord stimulation, 48 sulodexide, 49 and hemodilution. 50 Multiple types of medication were studied in some of the articles.…”

Section: Evidence Synthesismentioning

confidence: 99%

Medical adjunctive therapy for patients with chronic limb-threatening ischemia: a systematic review

et al. 2020

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The aim of this article is to systematically review the literature on medical adjunctive therapy for patients with chronic limbthreatening ischemia (ClTi). evidenCe aCQuisiTion: Medline, embase, and Cochrane database of systematic reviews were searched for studies published between January 1 st , 2009, and June 1 st , 2019. articles that studied medical treatment of ClTi patients and reported clinical outcomes were eligible. Main exclusion criteria were case reports <20 patients, incorrect publication type, and ClTi caused by Buerger disease. The primary end point was major amputation (above the ankle) in studies with a follow-up of ≥6 months. Secondary end points were other clinical end points such as death and wound healing. study quality was assessed according to the downs and Black checklist. EVIDENCE SYNTHESIS: Included were 42 articles: four focused on antiplatelet therapy, five on antihypertensive medication, 6 on lipid-lowering therapy, 16 on stem cell therapy, three on growth factors, five on prostanoids, and one study each on cilostazol, glucose-lowering therapy, spinal cord stimulation, sulodexide, and hemodilution. Calcium channel blockers, iloprost, cilostazol, and hemodilution showed significant improvement of limb salvage, but data are limited. Stem cell therapy showed no significant improvement of limb salvage but could potentially improve wound healing. Antiplatelets, antihypertensives, and statins showed significantly lower cardiovascular events rates but not evident lower major amputation rates. The quality of the studies was fair to good. ConClusions: Certain medical therapies serve to improve limb salvage next to revascularization in ClTi patients, whereas others are important in secondary prevention. Because high quality evidence is limited, further research is needed.

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No Association of Diabetic Duration or Insulin Use with the Prognosis of Critical Limb Ischemia after Endovascular Therapy

Cited by 6 publications

References 31 publications

Survival of diabetes patients with major amputation is comparable to malignant disease

Survival of diabetes patients with major amputation is comparable to malignant disease

Diabetes Mellitus and Lower Extremity Peripheral Artery Disease

Medical adjunctive therapy for patients with chronic limb-threatening ischemia: a systematic review

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