title: Comparison of initial hemodynamic response after endovascular therapy and open surgical bypass in patients with diabetes mellitus and critical limb ischemia.
abstract: BACKGROUND
  While endovascular (ENDO) therapy has increasingly become the initial intervention of choice to treat lower extremity peripheral arterial disease, reported outcomes for ENDO in patients with critical limb ischemia (CLI) and diabetes have been reported to be inferior compared to open bypass surgery (OPEN). Objective data assessing the hemodynamic success of ENDO compared to the established benchmark of OPEN are sparse. We therefore evaluated and compared early hemodynamic outcomes of ENDO and OPEN in patients with diabetes with CLI at a single academic center.
  
  
  METHODS
  We studied 85 consecutive patients with diabetes and CLI who underwent 109 interventions, either ENDO (n = 78) or OPEN (n = 31). The mean patient age was 69 years; 62% were men. All patients presented with either rest pain and/or ulcer/gangrene. Per protocol, all were assessed using ankle brachial index (ABI) and toe pressure (TP) determinations before and early postintervention.
  
  
  RESULTS
  Both ENDO (ΔABI = 0.36 ± 0.24, P < .0001; ΔTP = 35.6 ± 24.1, P < .0001) and OPEN (ΔABI = 0.39 ± 0.17, P < .0001; ΔTP = 34.3 ± 24.0, P < .0001) resulted in significant hemodynamic improvement. There was no statistically significant initial difference between the two types of intervention (ABI, P = .6; TP, P = .6).
  
  
  CONCLUSIONS
  These data suggest that with appropriate patient selection, each intervention is similarly efficacious in initially improving hemodynamics. If the intermediate or long-term results of ENDO for CLI in people with diabetes are inferior, the problem is not one of initial hemodynamic response, but more likely due to differing patient characteristics or durability of the intervention.
authors: Department of Surgery, Division of Vascular and Endovascular Surgery, University of Arizona, and Southern Arizona Limb Salvage Alliance, Tucson, AZ, USA.
authors: Luke X
authors: LX
authors: Zhan
authors: Manish
authors: M
authors: Bharara
authors: Matthew
authors: M
authors: White
authors: Sugam
authors: S
authors: Bhatnagar
authors: Brian
authors: B
authors: Lepow
authors: David G
authors: DG
authors: Armstrong
authors: Joseph L
authors: JL
authors: Mills
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000800:Angioplasty, Balloon; D003925:Diabetic Angiopathies / Q000503:physiopathology* / Q000601:surgery / Q000628:therapy*; D057510:Endovascular Procedures; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007511:Ischemia / Q000503:physiopathology* / Q000601:surgery / Q000628:therapy*; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D014656:Vascular Surgical Procedures