Characteristics and Outcomes of Patients With Diabetes Mellitus Undergoing Peripheral Vascular Intervention for Infrainguinal Symptomatic Peripheral Artery Disease
| Autor: | William A. Gray, Jihad Mustapha, E. Hope Weissler, Jennifer A. Rymer, Gary M. Ansel, Manesh R. Patel, Eric A. Secemsky, George L. Adams, Dennis I. Narcisse, Ehrin J. Armstrong, W. Schuyler Jones |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Arterial disease 030209 endocrinology & metabolism Disease 030204 cardiovascular system & hematology Amputation Surgical Article Peripheral Arterial Disease 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Diabetes mellitus Diabetes Mellitus Humans Medicine Prospective Studies Vascular Patency Aged Aged 80 and over business.industry Endovascular Procedures General Medicine Middle Aged PERIPHERAL VASCULAR INTERVENTION Limb Salvage medicine.disease United States Femoral Artery Treatment Outcome Female Surgery Cardiology and Cardiovascular Medicine business |
| Zdroj: | Vasc Endovascular Surg |
| ISSN: | 1938-9116 1538-5744 |
| DOI: | 10.1177/1538574420968671 |
| Popis: | Purpose: Patients with diabetes mellitus (DM) are known to be at higher risk for peripheral artery disease (PAD), amputations, and major adverse cardiovascular events, though it is unclear whether they are at any higher risk for repeat intervention. LIBERTY 360 offered an opportunity to study a real-world cohort of patients who underwent distal superficial femoral artery endovascular revascularizations. We aimed to describe patients with DM, their outcomes following peripheral vascular intervention, and the effect of DM on outcomes in the LIBERTY 360 cohort. Methods: LIBERTY 360 is a prospective, multi-center, non-randomized, mono-industry funded observational study of patients undergoing endovascular revascularization. Outcomes included 30-day and 1-year all-cause mortality, major amputation, target vessel/lesion revascularization, and a composite of those events. A multivariable regression model including DM was constructed to examine the effect of DM on outcomes. Multivariable survival estimates were made using Cox proportional hazards models. Results: A total of 1,204 patients were enrolled, of whom 727 had DM (60.4%). Patients with DM had significantly more comorbidities and a third required insulin for DM management. Patients with DM had more severe disease based on Rutherford classification at baseline. After adjusting for comorbidities and disease severity, DM patients had more frequent major amputations at 1 year (5.2% versus 1.2%; HR 2.71, 95%CI 1.05-6.98, p = 0.040). The 1-year rates of all-cause mortality and target vessel/lesion revascularization were not significantly higher for patients with DM. Conclusions: Diabetes mellitus was associated with increased major amputations at 1 year following endovascular revascularization after accounting for demographics, comorbidities, and PAD-related characteristics. Further research is needed to determine which aspects of PAD and DM are most strongly associated with poor outcomes following lower extremity revascularization. |
| Databáze: | OpenAIRE |
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