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Diabetes increases risk for amputation, death after endovascular treatment for PAD
Patients with diabetes and symptomatic peripheral artery disease are at a higher risk for major amputation and all-cause death at 12 months after endovascular revascularization, especially among those with critical limb ischemia, according to data published in the Journal of Endovascular Therapy.
However, researchers found no relationship between diabetes and target limb revascularization.
Diabetes “is a growing problem worldwide and in the United States is linked to the epidemic of obesity,” Subhash Banerjee, MD, professor of medicine at University of Texas Southwestern Medical Center and chief of the division of cardiology at the VA North Texas in Dallas, and colleagues wrote. “Diabetes is a major risk factor for PAD and leads to more diffuse calcified disease and higher rates of lower-extremity amputation.”
Researchers conducted a study involving 1,906 consecutive patients (mean age, 66 years; 77% men) from the observational XLPAD registry to determine the independent effect of diabetes on major limb outcomes at 1 year after endovascular treatment of lower-extremity PAD.
Patient outcomes were 12-month target limb amputation and target limb revascularization as well as all-cause death.
Banerjee and colleagues found that, in the cohort, there were higher rates comorbid conditions (P < .001), CLI (P < .001), heavily calcified lesions (P = .002), multivessel disease (P = .03) and fewer infrapopliteal runoff vessels (P < .001) among patients with diabetes.
There was significantly higher target limb major amputation in patients with diabetes compared with those without diabetes (HR = 5.02; 95% CI, 1.44-17.56) after adjustment for cofounders. Rates of repeat revascularization were similar between the groups.
Diabetes was associated with a nonsignificant increased risk for 12-month major amputation in patients presenting with CLI (HR = 3.48, 95% CI, 0.97-12.51), but the trend was not seen in patients with claudication.
Additionally, researchers found an association between diabetes and increased risk for 12-month all-cause mortality in the overall cohort (HR = 4.64; 95% CI, 2.01-10.7) and in the CLI subgroup (HR = 14.15; 95% CI, 3.16-63.32), but not in the claudication subgroup (HR = 1.42, 95% CI, 0.45-4.54).
“Our data indicated that target limb revascularization following lower-extremity endovascular interventions in diabetics is similar to nondiabetics after adjusting for comorbid conditions and pharmacotherapy factors, however with higher all-cause mortality,” the researchers wrote. “Our findings contradict some of previously published studies that indicate that diabetes is associated with worse repeat revascularization outcomes.” – by Dave Quaile
Disclosures: Banerjee reports receiving research grants from Boston Scientific and The Medicines Company; receiving consultant or speaker honoraria from Boehringer Ingelheim, Cordis, Gilead, Medtronic, Sanofi and St. Jude Medical; holding intellectual property with HygeiaTel; and his spouse is an owner of Mdcare Global. Please see the study for all other authors’ relevant financial disclosures.