Endovascular treatment of lower extremity arteries is associated with an improved outcome in diabetic patients affected by intermittent claudication

BMC Surgery

Research Article

Cinzia Perrino¹  Marco Ferrone¹  Anna Sannino¹  Giuseppe Giugliano¹  Andreina Carbone¹  Fernando Scudiero¹  Vittorio Schiano¹  Linda Brevetti¹  Bruno Trimarco¹  Giovanni Esposito¹  Giuseppe Gargiulo¹  Federica Serino¹  Antonio Bruno¹  Gabriele Giacomo Schiattarella¹  Bruno Amato² 

[1] Department of Clinical Medicine and Cardiovascular and Immunological Sciences, “Federico II” University”, via Pansini 5, 80131, Naples, Italy;Department of General, Geriatric, Oncologic Surgery and Advanced Technologies, “Federico II” University”, via Pansini 5, 80131, Naples, Italy;

关键词: Critical Limb Ischemia;    Intermittent Claudication;    Major Cardiovascular Event;    Maximal Medical Therapy;    Classic Cardiovascular Risk Factor;   

DOI  :  10.1186/1471-2482-12-S1-S19

来源: Springer

【 摘 要 】

BackgroundLower 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.Methods236 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.ResultsNo 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).ConclusionsThe 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.

【 授权许可】

Unknown   
© Giugliano et al; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.