Dm
CLINICAL PRACTICE
The Effect of Diabetes Mellitus on the Outcome of Angioplasty for l o w e r Limb Ischaemia A.H. Davies, S.E. Cole, T.R. Magee, D.J.A. Scott, R.N. Baird, M. Horrocks Department of Vascular Studies, Bristol Royal Infirmary, Bristol, UK
Angioplasty is an important tool in the armamentarium of the clinician dealing with atherosclerotic disease. Diabetic patients with occlusive disease pose special problems. Four hundred and twenty-five lesions were dilated in 370 patients. No difference in site was found when comparing the diabetic and non-diabetic groups ( p < O.OOl), but a significant difference in indication for treatment was observed. Cumulative patency at 5 years for iliac lesions in non-diabetic patients was 61.2 % and in diabetic patients was 35.6 % ( p < 0.05), for superficial femoral and popliteal artery lesions in non-diabetic patients it was 49.7 % and in diabetic patients it was 38.8 % (NS). The need for subsequent surgical intervention ( p < 0.01) and risk of death ( p < 0.001) are both significantly greater in the diabetic group. This study shows that angioplasty is a technique that can be used with success in diabetic patients and if the indications for intervention are compared, diabetic patients do no worse. KEY WORDS
Diabetes mellitus Angioplasty
Peripheral vascular disease
Introduction
Results
The management of diabetic vascular disease remains a major problem. Since the development of the technique of intraluminal dilatation,’*2 not only have the indications for its use changed’ but the effect of diabetes on the eventual outcome following dilatation has remained uncertain. Two groups have reported a significantly poorer outcome in diabetic patient^^,^ whereas others6,’ have shown no difference after angioplasty. We have assessed prospectively a cohort of patients undergoing angioplasty at the Bristol Royal Infirmary between 1980 and 1987, and investigated the effect of diabetes mellitus on outcome.
These are summarized in Table 1. Four hundred and twenty-five lesions were dilated in 370 patients. In total 229 patients (62 %) presented wth claudication, 19 (8 %) of whom had diabetes and 141 patients (38 %) presented with critical ischaemia, 39 (28 %) of whom had diabetes. The indication for treatment in the non-diabetic population compared to the diabetic group was significantly different ( X 2=33;p < 0.001). There was no significant difference in the site of the lesions requiring treatment in either group. The run-off angiographic scores in both
Table 1. Comparison of diabetic and non-diabetic patients undergoing angioplasty for lower limb ischaemia
Patients and Methods Between 1980 and 1987 370 patients (277 males and 93 females) underwent attempted angioplasty. The mean age of the patients at presentation was 63 years (32-91 1. Following angioplasty all the patients were followed up in our Vascular Studies Laboratory. Follow up was conducted at 1, 3, 6, and- 12 months and thereafter annually. All data was recorded prospectively on the Bristol In Patient Audit System (BIPAS). Statistical analysis of cumulative patency was performed using log-rank analysis. Chi-squared tests with a Yates’ correction were used for the remaining comparisons.
Correspondence to: Mr A.H. Davies, Department of Vascular Studies, Bristol Royal Infirmary, Bristol, BS2 8HW, UK.
480
0742-3071 /92/050480-02$05 .OO & Sons, Ltd.
0 1992 by John Wiley
Site Iliac and aorta Femoral and popliteal Indication Claudication Critical isc haem ia Cumulative patency Iliac and aorta Femoral and popliteal Requirement for surgery Mortality
Nondiabetic patients (n=312)
Diabetic patients (n=58)
p
51.3 % 48.7 %
46.5 % 53.5 %
NS
;;:;2 ;;:;2
CLINICAL PRACTICE
The Effect of Diabetes Mellitus on the Outcome of Angioplasty for l o w e r Limb Ischaemia A.H. Davies, S.E. Cole, T.R. Magee, D.J.A. Scott, R.N. Baird, M. Horrocks Department of Vascular Studies, Bristol Royal Infirmary, Bristol, UK
Angioplasty is an important tool in the armamentarium of the clinician dealing with atherosclerotic disease. Diabetic patients with occlusive disease pose special problems. Four hundred and twenty-five lesions were dilated in 370 patients. No difference in site was found when comparing the diabetic and non-diabetic groups ( p < O.OOl), but a significant difference in indication for treatment was observed. Cumulative patency at 5 years for iliac lesions in non-diabetic patients was 61.2 % and in diabetic patients was 35.6 % ( p < 0.05), for superficial femoral and popliteal artery lesions in non-diabetic patients it was 49.7 % and in diabetic patients it was 38.8 % (NS). The need for subsequent surgical intervention ( p < 0.01) and risk of death ( p < 0.001) are both significantly greater in the diabetic group. This study shows that angioplasty is a technique that can be used with success in diabetic patients and if the indications for intervention are compared, diabetic patients do no worse. KEY WORDS
Diabetes mellitus Angioplasty
Peripheral vascular disease
Introduction
Results
The management of diabetic vascular disease remains a major problem. Since the development of the technique of intraluminal dilatation,’*2 not only have the indications for its use changed’ but the effect of diabetes on the eventual outcome following dilatation has remained uncertain. Two groups have reported a significantly poorer outcome in diabetic patient^^,^ whereas others6,’ have shown no difference after angioplasty. We have assessed prospectively a cohort of patients undergoing angioplasty at the Bristol Royal Infirmary between 1980 and 1987, and investigated the effect of diabetes mellitus on outcome.
These are summarized in Table 1. Four hundred and twenty-five lesions were dilated in 370 patients. In total 229 patients (62 %) presented wth claudication, 19 (8 %) of whom had diabetes and 141 patients (38 %) presented with critical ischaemia, 39 (28 %) of whom had diabetes. The indication for treatment in the non-diabetic population compared to the diabetic group was significantly different ( X 2=33;p < 0.001). There was no significant difference in the site of the lesions requiring treatment in either group. The run-off angiographic scores in both
Table 1. Comparison of diabetic and non-diabetic patients undergoing angioplasty for lower limb ischaemia
Patients and Methods Between 1980 and 1987 370 patients (277 males and 93 females) underwent attempted angioplasty. The mean age of the patients at presentation was 63 years (32-91 1. Following angioplasty all the patients were followed up in our Vascular Studies Laboratory. Follow up was conducted at 1, 3, 6, and- 12 months and thereafter annually. All data was recorded prospectively on the Bristol In Patient Audit System (BIPAS). Statistical analysis of cumulative patency was performed using log-rank analysis. Chi-squared tests with a Yates’ correction were used for the remaining comparisons.
Correspondence to: Mr A.H. Davies, Department of Vascular Studies, Bristol Royal Infirmary, Bristol, BS2 8HW, UK.
480
0742-3071 /92/050480-02$05 .OO & Sons, Ltd.
0 1992 by John Wiley
Site Iliac and aorta Femoral and popliteal Indication Claudication Critical isc haem ia Cumulative patency Iliac and aorta Femoral and popliteal Requirement for surgery Mortality
Nondiabetic patients (n=312)
Diabetic patients (n=58)
p
51.3 % 48.7 %
46.5 % 53.5 %
NS
;;:;2 ;;:;2
