Clinical outcome of primary infrainguinal subintimal angioplasty in diabetic patients with critical lower limb ischemia.
OBJECTIVE
To evaluate the clinical outcome of subintimal angioplasty in diabetic patients with critical limb ischemia (CLI) compared to nondiabetics irrespective of the patency status of the treated arteries.


METHODS
The records of 99 consecutive patients (53 men; median age 78.5 years, range 42-92) suffering from CLI who underwent primary infrainguinal subintimal angioplasty in 112 limbs within a 6-month period were studied retrospectively. A third of the patients (n=33) were diabetic. The technical success, perioperative morbidity/mortality, and clinical success were compared between the diabetic and nondiabetic patients. Kaplan-Meier life-table analysis was used to analyze clinical success, limb salvage, and survival for both groups.


RESULTS
The overall technical success was 89% (81% in diabetics, 93% in nondiabetics, p=0.05). Perioperative morbidity was 8% (16.7% in diabetics, 3.9% in nondiabetics, p=0.03). The perioperative mortality was zero. The clinical success at 12, 24, and 36 months was 74%, 72%, and 65% in nondiabetics and 69%, 63%, and 54% in diabetics, respectively (p=0.17). The limb salvage rate at 36 months was 88% overall (90% in nondiabetics, 82% among diabetics, p=0.20). The 36-month survival rate was 61% in nondiabetics and 57% in diabetics (p=0.29).


CONCLUSIONS
In terms of clinical outcome, infrainguinal subintimal angioplasty is almost equally effective in diabetics as in nondiabetics suffering from CLI.
Department of Surgery, Leicester Royal Infirmary, Leicester, England, UK. andreaslazaris@hotmail.com
Andreas M
AM
Lazaris
Achilleas C
AC
Tsiamis
Guy
G
Fishwick
Amman
A
Bolia
Peter R F
PR
Bell
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007264:Inguinal Canal / Q000098:blood supply / Q000601:surgery; D007511:Ischemia / Q000150:complications / Q000601:surgery*; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome