Endovascular and surgical treatment of chronic limb ischaemia in diabetics

S. Losa, A. Ruscazio, E. Faglia, M. Mantero, L. Gabrielli

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Aim. The presence of chronic limb ischaemia in diabetic patients is 4 times higher than in the normal population, with the risk of amputation 25% higher within 1 year. We examined the results of an aggressive attitude towards this disease, compared with a more conservative attitude found in the literature. Methods. Between April and December 2000, we treated 50 diabetic patients with peripheral arteriopathy and distal trophic lesions (59 extremities treated); 38 endovascular procedures (36 tibial artery PTA; 1 popliteal artery and 1 superficial femoral artery PTA), 15 infragenicular bypasses (9 on the lower popliteal artery and 6 on the tibial arteries) and 5 femoral-popliteal- supragenicular bypasses. In 1 case we only carried out an exploration of the tibial arteries. Before revascularisation, surgical cleaning of the trophic lesions was carried out; a minor amputation was carried out 10-15 days later on average. Results. Patients treated with tibial artery PTA were assessed by TcpO2 before and after treatment, and monitored clinically. Patients who underwent a surgical procedure were checked after 1, 2, 3, 6, 12 and 15 months by color Doppler scan and a clinical assessment. We considered limb salvage and healing of the trophic lesions as our primary end-point; our secondary end-points were patency in the bypass group and a TcpO2 increase in the tibial PTA group. Limb salvage, according to the Kaplan-Meier actuarial curve, was achieved in 89% of cases. The trophic lesions were healed in 37 out of 59 treated limbs; 6 cases underwent major amputation (3 thigh and 3 leg), 4 of which in the PTA group and 2 in the bypass group; 3 patients in the PTA group and 1 in the bypass group died as a result of other causes. Bypass patency 15 months later, according to the Kaplan-Meier curve, was 80% for supragenicular bypass and 69.2% for infragenicular. Mean TcpO2 before and after treatment increased from 22.37 (DS 12.78) to 49.21 (DS 16.83), (p=0). Conclusion. In our experience distal endovascular procedures in the diabetic patient and/or surgical revascularisation allow us to obtain a high clinical success rate and to drastically reduce the major amputation rate.

Original languageEnglish
Title of host publicationItalian Journal of Vascular and Endovascular Surgery
Pages35-39
Number of pages5
Volume11
Edition1
Publication statusPublished - Mar 2004

Keywords

  • Angioplasty, balloon
  • Diabetic angio pathies
  • Extremities
  • Ischemia
  • Tibial arteries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Losa, S., Ruscazio, A., Faglia, E., Mantero, M., & Gabrielli, L. (2004). Endovascular and surgical treatment of chronic limb ischaemia in diabetics. In Italian Journal of Vascular and Endovascular Surgery (1 ed., Vol. 11, pp. 35-39)