Long term outcomes in diabetic patients treated with atherectomy for peripheral artery disease
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: atherectomydiabetes mellitusperipheral artery diseasecritical limb ischemiaclaudicationbelow the kneeabove the knee
References
- Whiting DR, Guariguata L, Weil C, et al. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011; 94(3): 311–321.
- Fowkes FG, Rudan D, Rudan I, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013; 382(9901): 1329–1340.
- Criqui MH. Peripheral arterial disease--epidemiological aspects. Vasc Med. 2001; 6(3 Suppl): 3–7.
- O'Hare AM, Glidden DV, Fox CS, et al. High prevalence of peripheral arterial disease in persons with renal insufficiency: results from the National Health and Nutrition Examination Survey 1999-2000. Circulation. 2004; 109(3): 320–323.
- Suzuki JI, Shimamura M, Suda H, et al. Current therapies and investigational drugs for peripheral arterial disease. Hypertens Res. 2016; 39(4): 183–191.
- Lee MS, Rha SW, Han SK, et al. Comparison of diabetic and non-diabetic patients undergoing endovascular revascularization for peripheral arterial disease. J Invasive Cardiol. 2015; 27(3): 167–171.
- Darling JD, Bodewes TCF, Deery SE, et al. Outcomes after first-time lower extremity revascularization for chronic limb-threatening ischemia between patients with and without diabetes. J Vasc Surg. 2018; 67(4): 1159–1169.
- Jude EB, Oyibo SO, Chalmers N, et al. Peripheral arterial disease in diabetic and nondiabetic patients: a comparison of severity and outcome. Diabetes Care. 2001; 24(8): 1433–1437.
- Janas A, Buszman PP, Milewski KP, et al. Long-Term outcomes after percutaneous lower extremity arterial interventions with atherectomy vs. Balloon angioplasty: propensity score-matched registry. Circ J. 2017; 81(3): 376–382.
- Marso SP, Hiatt WR. Peripheral arterial disease in patients with diabetes. J Am Coll Cardiol. 2006; 47(5): 921–929.
- Garcia LA, Jaff MR, Rocha-Singh KJ, et al. A comparison of clinical outcomes for diabetic and nondiabetic patients following directional atherectomy in the DEFINITIVE LE claudicant cohort. J Endovasc Ther. 2015; 22(5): 701–711.
- Oz II, Serifoglu I, Bilici M, et al. Comparison of drug-eluting balloon and standard balloon angioplasty for infrapopliteal arterial diseases in diabetic patients. Vasc Endovascular Surg. 2016; 50(8): 534–540.
- Fanelli F, Di Primo M, Boatta E, et al. Drug-eluting nitinol stent treatment of the superficial femoral artery and above-the-knee popliteal artery (the Zilver PTX single-arm clinical study): a comparison between diabetic and nondiabetic patients. Cardiovasc Intervent Radiol. 2013; 36(5): 1232–1240.
- Dick F, Diehm N, Galimanis A, et al. Surgical or endovascular revascularization in patients with critical limb ischemia: influence of diabetes mellitus on clinical outcome. J Vasc Surg. 2007; 45(4): 751–761.
- Stavroulakis K, Bisdas T, Torsello G, et al. Combined directional atherectomy and drug-eluting balloon angioplasty for isolated popliteal artery lesions in patients with peripheral artery disease. J Endovasc Ther. 2015; 22(6): 847–852.
- Tellez A, Dattilo R, Mustapha JA, et al. Biological effect of orbital atherectomy and adjunctive paclitaxel-coated balloon therapy on vascular healing and drug retention: early experimental insights into the familial hypercholesterolaemic swine model of femoral artery stenosis. EuroIntervention. 2014; 10(8): 1002–1008.
- Granada JF, Tellez A, Baumbach WR, et al. In vivo delivery and long-term tissue retention of nano-encapsulated sirolimus using a novel porous balloon angioplasty system. EuroIntervention. 2016; 12(6): 740–747.
- Iida O, Yokoi H, Soga Y, et al. Cilostazol reduces angiographic restenosis after endovascular therapy for femoropopliteal lesions in the Sufficient Treatment of Peripheral Intervention by Cilostazol study. Circulation. 2013; 127(23): 2307–2315.
- Andrews RK, Berndt MC. Platelet physiology and thrombosis. Thromb Res. 2004; 114(5-6): 447–453.
- Biondi-Zoccai GG, Agostoni P, Abbate A. Parallel hierarchy of scientific studies in cardiovascular medicine. Ital Heart J. 2003; 4(11): 819–820.
