Kenji Suzuki1, Osamu Iida2, Yasutaka Yamauchi3, Masatsugu Nakano4, Yoshimitsu Soga5, Daizo Kawasaki6, Junichi Tazaki7, Terutoshi Yamaoka8, Nobuhiro Suematsu9, Yoshiaki Shintani10, Yusuke Miyashita11, Naoto Inoue1, Taiichiro Meguro1. 1. Cardiovascular Center, Sendai Kousei Hospital, Hirosemachi, Aoba-ku, Sendai, Miyagi, Japan. 2. Cardiovascular Division, Kansai Rosai Hospital, Inabaso, Amagasaki, Hyogo, Japan. 3. Cardiovascular Center, Kikuna Memorial Hospital, Kikuna, Kohoku, Yokohama, Kanagawa, Japan. 4. Department of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, Japan. 5. Department of Cardiology, Kokura Memorial Hospital, Kibune-cho, Kita-ku, Kokura, Kitakyushu, Fukuoka, Japan. 6. Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho, Nishinomiya, Hyogo, Japan. 7. Department of Circulatory Organs, Kyoto University Hospital, Kawahara-cho, Shogo-in, Sakyo-ku, Kyoto, Kyoto, Japan. 8. Department of Vascular Surgery, Matsuyama Red Cross Hospital, Bunkyo-cho, Matsuyama, Ehime, Japan. 9. Department of Cardiology, Japanese Red Cross Fukuoka Hospital, Okusu-cho, Minami-ku, Fukuoka, Fukuoka, Japan. 10. Department of Cardiology, Shin-Koga Hospital, Tenjin-cho, Kurume, Fukuoka, Japan. 11. Department of Advanced PAD Therapeutics, Shinshu University Hospital, Asahi, Matsumoto, Nagano, Japan.
Abstract
BACKGROUND: A strong association exists between diabetes mellitus and critical limb ischemia. METHODS AND RESULTS: We performed endovascular therapy on 1060 limbs in 884 patients with below knee lesions only. The patients were divided into diabetes (DG) and nondiabetes groups (NDG). Limb salvage was poorer in the DG (79% vs 89%, P = .0061). No significant difference was observed in mortality, amputation-free survival (AFS), and target vessel revascularization (TVR). Multivariate analysis revealed diabetes status, infection, poor activity of daily living (ADL), younger age, and procedure failure as independent predictors of major amputation in DG. In the NDG, procedure failure was the predictor, and younger age and poor ADL showed tendency of major amputation. CONCLUSIONS: Mortality, AFS, and TVR showed no significant difference between the 2 groups, but major amputation was more frequent in DG. Not only revascularization but also infection and diabetes control were very important for limb salvage in DG.
BACKGROUND: A strong association exists between diabetes mellitus and critical limb ischemia. METHODS AND RESULTS: We performed endovascular therapy on 1060 limbs in 884 patients with below knee lesions only. The patients were divided into diabetes (DG) and nondiabetes groups (NDG). Limb salvage was poorer in the DG (79% vs 89%, P = .0061). No significant difference was observed in mortality, amputation-free survival (AFS), and target vessel revascularization (TVR). Multivariate analysis revealed diabetes status, infection, poor activity of daily living (ADL), younger age, and procedure failure as independent predictors of major amputation in DG. In the NDG, procedure failure was the predictor, and younger age and poor ADL showed tendency of major amputation. CONCLUSIONS: Mortality, AFS, and TVR showed no significant difference between the 2 groups, but major amputation was more frequent in DG. Not only revascularization but also infection and diabetes control were very important for limb salvage in DG.