Principal predictors of major adverse limb events in diabetic peripheral artery disease: A narrative review

Abstract

Background and aims: The increasing prevalence of diabetes mellitus is causing a massive growth of peripheral artery disease incidences, a disabling complication of diabetic atherosclerosis, which leads often to the amputation of the affected limb. Critical limb ischemia is the terminal disease stage, which requires a prompt intervention to relieve pain and save limbs. However, patients undergoing revascularization often suffer from cardiovascular, cerebrovascular and major adverse limb events with poor outcomes. Furthermore, the same procedure performed in apparently similar patients has various outcomes and lack of an outcome predictive support causes a high lower limb arterial revascularization rate with disastrous effects for patients. We collected the main risk factors of major adverse limb events in a more readable and immediate format of the topic, to propose an overview of parameters to manage effectively peripheral artery disease patients and to propose basics of a new predictive tool to prevent from disabling vascular complications of the disease.

Methods: Most recent and updated literature about the prevalence of major adverse limb events in peripheral artery disease was reviewed to identify possible main predictors.

Results: In this article, we summarized major risk factors of limb revascularization failure and disabling vascular complications collecting those parameters principally responsible for major adverse limb events, which provides physio-pathological explanation of their role in peripheral artery disease.

Conclusion: We evaluated and listed a panel of possible predictors of MALE (Major Adverse Limb Event) in order to contribute to the development of a predictive score, based on a summary of the main risk factors reported in scientific articles, which could improve the management of peripheral artery disease by preventing vascular accidents.

Keywords: Critical limb ischemia; Diabetes mellitus; Major adverse limb event (MALE); Peripheral artery disease; Predictors.

Fig. 1

Predictors of Male: Main risk factors promoting the atherosclerotic process underlying peripheral artery disease. All possible predictors of major adverse limb events. MALE: Major Adverse Limb Event; BMP’s: Bone Morphogenetic Proteins; VSMCs: Vascular Smooth Muscle Cell; NFkB: Nuclear Factor Kappa-light-chain-enhancer of activated B cells; ROS: Reactive Oxygen Species; LDL: Low-Density Lipoprotein; eNOs: endothelial Nitric Oxide Synthase; MACE: Major Adverse Cardio/Cerebrovascular Event; ABI: Ankle-Brachial Index.