title: Endovascular treatment of lower extremity arteries is associated with an improved outcome in diabetic patients affected by intermittent claudication.
abstract: BACKGROUND
  Lower extremity peripheral arterial disease (LE-PAD) is a highly prevalent condition among diabetic patients, associated with reduced walking capacity and a high incidence of cardiovascular events. Endovascular revascularization of lower extremities arteries improves walking performance and quality of life of diabetic patients affected by intermittent claudication, but few studies evaluated the impact of revascularization on cardiovascular outcome in this high-risk population. Accordingly, in the present study we evaluated if leg-ischemia resolution by effective lower limbs percutaneous revascularization can also impact cardiovascular outcome in a homogeneous group of diabetic patients affected by intermittent claudication.
  
  
  METHODS
  236 diabetic patients affected by LE-PAD at stage II of Fontaine's classification, with ankle/brachial index ≤ 0.90 and one or more hemodynamically significant stenosis in at least one artery of the ileo-femoro-popliteal axis were enrolled in the study. According to the Trans-Atlantic Inter Society Consensus II recommendations, 123 (52.1%) underwent percutaneous transluminal angioplasty (PTA group), while 113 (47.9%) underwent conservative medical therapy only (MT group). The incidence of major cardiovascular events (cardiovascular death, myocardial infarction, ischemic stroke, coronary or carotid revascularization) was prospectively analyzed with Kaplan-Meier curves and the risk of developing a cardiovascular event calculated by Cox analyses.
  
  
  RESULTS
  No baseline difference in cardiovascular risk factors were observed between the PTA and MT groups, except for a lower prevalence of males in PTA group (74.8% vs. 85.8%, p=0.034). Furthermore, patients in the PTA group showed a worse walking capacity as expressed by maximum walking distance (108.7 ± 300.9 vs 378.4 ± 552.3 meters, p<0.001). During a median follow-up of 20 months (12.0-29.0), the incidence of cardiovascular events was markedly lower in patients in the PTA group with respect to patients in the MT group (7.3% vs. 22.1%, p=0.001), and patients of the MT group had at Cox analysis a 3.9 increased risk with respect to PTA group, after adjustment for potential confounding factors (95% CI 1.1-15.3, p=0.049).
  
  
  CONCLUSIONS
  The present study shows that lower limbs revascularization of diabetic patients affected by intermittent claudication, in addition to improve walking performance, is associated with a reduction in the incidence of future major cardiovascular events.
authors.affiliation: Department of Clinical Medicine and Cardiovascular and Immunological Sciences, Federico II University, via Pansini 5, 80131 Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giugliano
authors.forename: Cinzia
authors.initials: C
authors.lastname: Perrino
authors.forename: Vittorio
authors.initials: V
authors.lastname: Schiano
authors.forename: Linda
authors.initials: L
authors.lastname: Brevetti
authors.forename: Anna
authors.initials: A
authors.lastname: Sannino
authors.forename: Gabriele Giacomo
authors.initials: GG
authors.lastname: Schiattarella
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gargiulo
authors.forename: Federica
authors.initials: F
authors.lastname: Serino
authors.forename: Marco
authors.initials: M
authors.lastname: Ferrone
authors.forename: Fernando
authors.initials: F
authors.lastname: Scudiero
authors.forename: Andreina
authors.initials: A
authors.lastname: Carbone
authors.forename: Antonio
authors.initials: A
authors.lastname: Bruno
authors.forename: Bruno
authors.initials: B
authors.lastname: Amato
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
authors.forename: Giovanni
authors.initials: G
authors.lastname: Esposito
mesh_terms: D000368:Aged; D017130:Angioplasty; D002340:Carotid Artery Diseases / Q000209:etiology / Q000517:prevention & control; D003324:Coronary Artery Disease / Q000209:etiology / Q000517:prevention & control; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D003925:Diabetic Angiopathies / Q000150:complications / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D058729:Peripheral Arterial Disease / Q000150:complications / Q000628:therapy*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D016896:Treatment Outcome; D016138:Walking