Efficacy of endoluminal interventional therapy in diabetic peripheral arterial occlusive disease: a retrospective trial

Abstract

Background: The purpose of this study was to assess the efficacy of interventional therapy for peripheral arterial occlusive disease and the difference between diabetic patients and non-diabetic patients.

Methods: 139 consecutive patients between September 2006 and September 2010 who underwent percutaneous lower extremity revascularization for arterial lesions were divided into diabetes group (n = 62) and non-diabetes group (n = 77). Before intervention, rest ankle brachial indexes and three dimensional computed tomography angiography from abdominal aorta to tiptoe were performed. The interventional treatments included angioplasty with or without stenting. The clinical outcomes included rest ankle-brachial indexes, primary patency rates, secondary patency rates and limb-salvage rates for 6-month, 12-month, 24-month and 36-month after treatment. The primary and secondary patency rates of all interventions and the limb-salvage rates of the patients are illustrated by Kaplan-Meier curves and compared by log-rank analysis.

Results: The interventional operation success rates were 98.4% (61/62) in diabetes group and 100% (77/77) in non-diabetes group. The re-interventional operation success rates were 85.7% (18/21) in diabetes group and 76.9% (20/26) in non-diabetes group. The mean value of ankle brachial indexes was significantly increased after intervention (0.397 ± 0.125 versus 0.779 ± 0.137, t = -25.780, P < 0.001) in diabetes group and (0.406 ± 0.101 versus 0.786 ± 0.121, t = -37.221, P < 0.001) in non-diabetes group. Perioperative 30-day mortality was 0%. Major complications included groin hematoma in 7.2%, and pseudoaneurysm formation 2.2%. In diabetes group, 6, 12, 24, and 36-month primary patency rates were 88.7% ± 4.0%, 62.3% ± 6.6%, 55.3% ± 7.0%, and 46.5% ± 7.5%; secondary patency rates were 93.5% ± 3.1%, 82.3% ± 5.1%, 70.8% ± 6.5%, and 65.7% ± 7%; limb-salvage rates were 95.2% ± 2.7%, 87.7% ± 4.4%, 85.5% ± 4.8%, and 81.9% ± 5.8%. In non-diabetes group, 6, 12, 24, and 36-month primary patency rates were 90.9% ± 3.3%, 71.8% ± 5.4%, 71.8% ± 5.4%, and 60.9% ± 6.2%; secondary patency rates were 96.1% ± 2.2%, 91.6% ± 3.3%, 82.7% ± 4.8%, and 71.8% ± 6.2%; limb-salvage rates were 97.4% ± 1.8%, 94.4% ± 2.7%, 90.6% ± 3.7%, and 83.1% ± 5.4%. The differences between two groups were not significant (P > 0.05).

Conclusion: With a low risk of morbidity and mortality, the percutaneous revascularization accepted by patients does not affect ultimate necessary surgical revascularization and consequently should be considered as the preferred therapy for chronic lower extremity ischemia. The efficacy and prognosis of interventional therapy in diabetic patients is similar that in non-diabetic patients.

Figure 1

Primary patency rates of two groups.

Figure 2

Secondary patency rates of two groups.

Figure 3

Limb-salvage rates of two groups.

Figure 4

Iliaco-femoral arterial long occlusion. (a) DSA displayed right iliac artery overall occlusion; (b) after PTA and stenting, blood flow in right iliac artery was recovered; (c) DSA displayed right superficial femoral artery overall occlusion; (d) after PTA and stenting, blood flow in right superficial femoral artery was recovered.

Figure 5

Popliteal arterial long occlusion case. (a) DSA displayed left popliteal artery overall occlusion; (b) after PTA and stenting, blood flow in left popliteal artery was recovered.

Figure 6

Anterior tibial artery long occlusion case. (a) DSA displayed left anterior tibial artery long occlusion; (b-e) Deep balloon (2.5 mm × 80 mm) dilated the anterior tibial artery; (f) after PTA, blood flow in left anterior tibial artery was recovered.

Figure 7

Primary, secondary patency rates for iliac lesions in two groups.

Figure 8

Primary, secondary patency rates for femoral lesions in two groups.

Figure 9

Primary, secondary patency rates for popliteal lesions in two groups.

Figure 10

Primary, secondary patency rates for tibial lesions in two groups.