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. 2020;27(5):600-607.
doi: 10.5603/CJ.a2018.0122. Epub 2018 Nov 5.

Long term outcomes in diabetic patients treated with atherectomy for peripheral artery disease

Adam J Janas  1 , Krzysztof P Milewski  2 , Piotr P Buszman  2 , Wojciech Trendel  2 , Aleksandra Kolarczyk-Haczyk  2 , Mariusz Hochuł  2 , Maciej Pruski Jr  2 , Wojciech Wojakowski  2 , Paweł E Buszman  2 , Radosław S Kiesz  2
Affiliations

Long term outcomes in diabetic patients treated with atherectomy for peripheral artery disease

Adam J Janas et al. Cardiol J. 2020.

Abstract

Background: The prevalence of diabetes has increased significantly in well-developed countries during the last decade and it continues to grow. Diabetes increases the risk of restenosis in patients treated percutaneously for peripheral artery disease. The present study sought to compare outcomes of atherectomy treatment in diabetic (DM) vs. non-diabetic (nDM) patients suffering from peripheral artery disease.

Method: Between 2008 and 2012, 204 revascularization atherectomy procedures were performed on arteries of the lower extremities. The endpoints included target lesion revascularization (TLR), amputation and death. The type of atherectomy (excisional-soft plaque, orbital-calcified plaque, with active aspiration - with a thrombus) was left to operator discretion.

Results: This study contains 132 DM (66% male, age 68 ± 11.2 years) and 72 nDM (63% male, age 75 ± 11.3 years) subjects. DM were younger but had a higher prevalence of coronary artery disease (DM: 91% vs. nDM: 62%, p < 0.0001) and end-stage renal disease (DM: 22% vs. nDM: 2.5%, p < 0.0001). There were no differences in critical limb ischemia between the groups (DM: 21% vs. nDM: 12%, p = = 0.13). Mean time of follow-up was 384 and 411 days in DM and nDM, respectively (p = 0.43). There were no significant differences in TLR (DM: 15.2% vs. nDM: 22.2%, p = 0.249), amputations (DM: 3.0% vs. nDM: 1.5%, p = NS) or death rates (DM: 2.2% vs. nDM: 2.7%, p = NS). Kaplan-Mayer analysis showed no significant differences between the groups in the time to TLR, amputation or death.

Conclusions: Plaque modification with adjusted atherectomy appears to have similar outcomes in diabetic as well as in non-diabetic patients. Nonetheless, a randomized study would be warranted to confirm the findings of the current study.

Keywords: above the knee; atherectomy; below the knee; claudication; critical limb ischemia; diabetes mellitus; peripheral artery disease.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1
Figure 1
Target lesion revascularization (A), amputation and death (B) ratio; DM — diabetic patients; nDM — non-diabetic patients.
Figure 2
Figure 2
Kaplan-Mayer curves showing target lesion revascularization (TLR) free survival time (A), amputation free survival time (B) and survival time (C); DM — diabetic patients; nDM — non-diabetic patients.
Figure 3
Figure 3
Rutherford classification prior and after treatment. DM — diabetic patients; nDM — non-diabetic patients.
See this image and copyright information in PMC

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