title: A 5-Year Follow-up Study to Assess Clinical Outcomes of Patients with Diabetes Undergoing Lower Limb Angiography for Significant Peripheral Artery Disease.
abstract: BACKGROUND
  The optimal management for patients with diabetes and peripheral vascular disease-intermittent claudication or critical limb ischemia (CLI)-remains undetermined.
  
  
  METHODS
  In a single-center retrospective analysis, we compared 1- and 5-year amputation-free survival rates in patients undergoing angiography subsequently treated with medical therapy or revascularization.
  
  
  RESULTS
  78 patients were included, 56 with CLI (mean age 77 years); 22 with claudication (mean age 75 years). Of the CLI cohort, 30 patients were medically treated. Their 1-year amputation-free survival rate was similar to those treated with revascularization (46.7% versus 50.0%, respectively). 8 patients in the claudicant cohort were treated conservatively. The 1-year amputation-free survival rate was 75.0% for conservative treatment versus 78.6% in those revascularized. Within the CLI cohort, in those conservatively treated 20% underwent major, and 16.7% minor amputations, compared to 15.4% and 23.1% in those revascularized. At 5 years in the claudicant cohort, the amputation-free survival rate was 37.5% with medical treatment, versus 71.4% for those treated with revascularization. For CLI, the 5-year amputation-free survival rate was 10% for conservative treatment, versus 26.9% for revascularization.
  
  
  CONCLUSIONS
  We found similar rates of amputation at 1 year for patients treated medically or revascularized. However, at 5 years, the amputation-free survival rate was markedly higher in revascularized patients compared to those medically managed. Our study highlights the potential role of predicting life expectancy when considering treatment, with the option of surgical treatment offered to those in whom survival is predicted to be longer than 5 years. However, larger studies with matched cohorts are now needed to confirm these findings.
authors.affiliation: Department of Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.
authors.forename: Yisu
authors.initials: Y
authors.lastname: Gu
authors.affiliation: St. George's University School of Medicine, Grenada, West Indies.
authors.forename: Chatchai
authors.initials: C
authors.lastname: Kokar
authors.affiliation: Diabetic Foot Clinic, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Gooday
authors.affiliation: Diabetic Foot Clinic, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.|Department of Vascular Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.
authors.forename: Darren
authors.initials: D
authors.lastname: Morrow
authors.affiliation: Diabetic Foot Clinic, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK. ketan.dhatariya@nnuh.nhs.uk.
authors.forename: Ketan
authors.identifier: http://orcid.org/0000-0003-3619-9579
authors.initials: K
authors.lastname: Dhatariya
keywords: Amputation; Angiography; Diabetes; Peripheral vascular disease