title: Critical limb ischaemia in a diabetic population from an Asian Centre: angiographic pattern of disease and 3-year limb salvage rate with percutaneous angioplasty as first line of treatment.
abstract: OBJECTIVE
  Lower extremity amputation prevention (LEAP) is an ongoing program in our institution aimed at salvaging limbs in patients with critical limb ischemia (CLI). Patients in the LEAP program with reconstructible anatomy on initial Doppler imaging received either bypass surgery or percutaneous transluminal balloon angioplasty (PTA). We present the 3 year limb salvage rate and angiographic disease patterns in 42 consecutive diabetic patients with CLI who received PTA in 2005.
  
  
  METHODS
  26 women and 16 men with diabetes between the ages of 45 and 91 years old (mean age, 70.8 years) received PTA in 2005. Presenting symptoms were rest pain (n = 22), pre-existing gangrene (n = 17), non-healing ulcer (n = 16) and cellulitis (n = 2). The aim of the PTA was to achieve straight-line flow from the abdominal aorta down to the patent dorsalis pedis or plantar arch, with limb salvage as the ultimate outcome. Failure of treatment was defined as any amputation above the level of a Syme's amputation or the need for further surgical bypass. Technical success was achieved in 90% (38 out of 42 patients).
  
  
  RESULTS
  Limb salvage rates were 93% at 1 month, 87% at 3 months, 82% at 6 months, 78% at 1 year, 69% at 2 years and 66% at 3 years. Mortality was 17% (n = 7) at 3 years. Of the 13 patients with failed therapy, 3 underwent bypass, 9 had amputations and 1 had bypass followed by amputation. Four of the cases required further intervention due to worsening gangrene and infection, while the remaining was due to persistent rest pain. The rest of the 32 patients had no lower limb related issues at the end of 3 years, with improvement of the presenting symptoms. Patterns of treated segments were aortoiliac occlusions (n = 3), pure infrapopliteal disease (n = 3), femoropopliteal with at least 1 good infrapopliteal run-off vessel (n = 14) and combined femoropopliteal and infrapopliteal disease (n = 25).
  
  
  CONCLUSIONS
  Involvement of infrapopliteal vessels that needs to be treated is common in Asian diabetics. While early limb salvage rates up to 1 year are similar, the 3 year limb salvage rates in Asian diabetics are lower than the western population.
authors: Diagnostic Radiology, Tan Tock Seng Hospital, Singapore.
authors: M
authors: M
authors: Tan
authors: U
authors: U
authors: Pua
authors: D E S
authors: DE
authors: Wong
authors: S J
authors: SJ
authors: Punamiya
authors: G C
authors: GC
authors: Chua
authors: N
authors: N
authors: Teo
references: Cochrane Database Syst Rev. 2008 Apr 16;(2):CD002000
references: 18425879
references: Diab Vasc Dis Res. 2006 Sep;3(2):122-3
references: 17058633
references: Eur J Vasc Endovasc Surg. 2006 Dec;32(6):663-7
references: 16935010
references: Curr Treat Options Cardiovasc Med. 2007 Apr;9(2):159-70
references: 17484818
references: Curr Diab Rep. 2004 Jun;4(3):213-8
references: 15132888
references: Circulation. 2001 Oct 23;104(17):2057-62
references: 11673346
references: J Diabetes Complications. 2001 Nov-Dec;15(6):320-7
references: 11711326
references: J Vasc Surg. 1992 Jan;15(1):167-74; discussion 174-5
references: 1728675
references: Diabetes Metab. 2005 Sep;31(4 Pt 1):370-5
references: 16369199
references: Ann Vasc Surg. 1989 Jul;3(3):273-7
references: 2673321
references: J Vasc Surg. 2005 Mar;41(3):423-35; discussion 435
references: 15838475
references: J Vasc Surg. 2004 Dec;40(6):1149-57
references: 15622369
references: Eur J Vasc Endovasc Surg. 2007 Apr;33(4):453-60
references: 17196848
references: Lancet. 2005 Dec 3;366(9501):1925-34
references: 16325694
references: J Vasc Surg. 1992 Jul;16(1):54-9
references: 1619725
references: Eur J Vasc Endovasc Surg. 2005 Jun;29(6):620-7
references: 15878541
references: J Vasc Interv Radiol. 2000 Sep;11(8):1021-31
references: 10997465
references: J Vasc Surg. 2006 Aug;44(2):296-302; discussion 302-3
references: 16814976
references: Vascular. 2006 Mar-Apr;14(2):63-9
references: 16956473
references: Catheter Cardiovasc Interv. 2005 Jan;64(1):12-7
references: 15619276
references: Acta Radiol Diagn (Stockh). 1983;24(5):401-13
references: 6666664