Day-case angioplasty in diabetic patients with critical ischemia.
OBJECTIVE
Recent studies have shown that percutaneous transluminal angioplasty (PTA) can be safely performed as a day-case procedure. Many centers consider diabetes mellitus as a contraindication to day-case PTA. In this study, the safety and efficacy of 95 day-case PTA in 66 diabetic patients with critical leg ischemia (CLI) were evaluated.


METHODS
Diabetic patients with CLI were assessed in a one-stop multidisciplinary outpatient clinic. Sixty-six outpatients with CLI deemed suitable for radiological intervention by non-invasive imaging (ultrasound angiology or magnetic resonance angiography) were scheduled for day-case PTA.


RESULTS
PTA was initially successful in 63 out of 66 patients (95%). In 3 patients (5%), PTA was not possible because the lesion could not be balloon dilated or crossed with a guide wire. Clinically suspected first, second and third re-stenosis confirmed by non-invasive studies occurred in 20 out of 63 (31%), 7 out of 20 (35%) and 2 out of 7 (28%) patients, respectively. Following PTA, debridement was performed in 11 patients (17%), minor amputation in 8 (13%) and major amputation in 3 (5%). Relief of the primary symptom of rest pain or healing of ulcers was achieved in 23 out of 32 (72%) and 25 out of 27 (92.5%) patients, respectively. No peri-interventional morbidity or mortality was encountered.


CONCLUSIONS
PTA is feasible and safe as a day-case procedure in diabetic patients with CLI. Re-stenosis can be managed by repeat day-case PTA.
Zayed
H A
HA
Department of Vascular Surgery, King's College Hospital, London, UK. zayedha@yahoo.com
Fassiadis
N
N
Jones
K G
KG
Edmondson
R D
RD
Edmonds
M E
ME
Evans
D R
DR
Wilkins
C J
CJ
Sidhu
P S
PS
Rashid
H I
HI
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000671:Amputation, Surgical; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D003251:Constriction, Pathologic; D003646:Debridement; D048909:Diabetes Complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012008:Recurrence; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency