Diyabetik ve non-diyabetik hasta gruplarında kronik ekstremite tehdit eden iskemide endovasküler tedavi etkinliğinin değerlendirilmesi

Year 2020, , 998 - 1002, 01.11.2020

Yusuf Salim Urcun , Arda Aybars Pala

https://doi.org/10.28982/josam.811915

Abstract

Amaç: Periferik arter hastalıkları, aterosklerozun neden olduğu günümüzde giderek yaygınlaşan hastalıklardır. Çalışmamızda Periferik Transluminal Anjiyoplasti (PTA) uygulanan kronik ekstremite tehdit eden bacak iskemisi olan, diyabetik ve non-diyabetik hasta gruplarının, klinik sonuçlarını değerlendirmeyi amaçladık.
Yöntemler: Haziran 2013 - Mart 2020 tarihleri arasında kronik ekstremite tehdit eden bacak iskemisi (Rutherford sınıf 4 ve üzeri) nedeniyle alt ekstremite arteriyel lezyonlarına (darlık / tıkanıklık) perkütan transluminal anjiyoplasti (PTA) işlemi uygulanan 150 hasta (84 diyabetik / 66 non-diyabetik) çalışmaya dahil edilmiştir.
Bulgular: Altı aylık primer açıklık oranları diyabetik ve diyabetik olmayan grupta sırasıyla %86,5 ve %93,3 idi. 12 aylık primer açıklık oranları %73,0 ve %73,3 iken; 12 aylık sekonder açıklık oranları ise %66,7 ve %77,8 idi. Açıklık oranları açısından gruplar arasında farklılık tespit edilmedi. Diyabetik hasta grubunda majör ampütasyon (%16,7-%6,1; P=0,003) ve toplam amputasyon oranları (%34,6-%22,8; P=0,004) istatistiksel olarak anlamlı düzeylerde daha yüksekti.
Sonuç: Endovasküler tedavi sonrası ekstremite tehdit eden kronik bacak iskemisi olan diyabetik ve diyabetik olmayan hasta gruplarında açıklık ve amputasyon oranları değerlendirildiğinde, her iki grupta da başarılı klinik sonuçlar bildirilmiştir. Güncel sonuçlarımız, endovasküler tedavinin ekstremite tehdit eden iskemide her iki hasta grubunda da etkili bir şekilde kullanılabileceğini göstermektedir.

Keywords

Ekstremite tehdit eden iskemi, Endovasküler girişim, Diabetes mellitus

Assessment of the efficacy of endovascular treatment in chronic limb-threatening ischemia in diabetic and non-diabetic patients

Abstract

Aim: Peripheral artery diseases are a very common manifestation of atherosclerosis. We assessed the clinical outcomes of diabetic versus non-diabetic patients with chronic limb-threatening leg ischemia who underwent Peripheral Transluminal Angioplasty (PTA).
Methods: The patients (84 diabetic/66 non-diabetic) who underwent percutaneous transluminal angioplasty (PTA) in the lower extremity arterial lesions (stenosis/occlusion) because of chronic limb-threatening leg ischemia (Rutherford class 4 and above) between June 2013 and March 2020 were included in the study.
Results: Six-month primary patency rates were 86.5% and 93.3% in the diabetic and non-diabetic group, respectively. The 12-month primary patency rates were 73.0% and 73.3%; and 12-month secondary patency rates were 66.7% and 77.8%. No differences were detected between the groups in terms of patency rates. Major amputation and total amputation rates were higher at statistically significant levels in the diabetic patient group (%16.7% vs. 6.1%; P=0.003) (34.6% vs. 22.8%); P=0.004)
Conclusion: When patency and amputation rates are evaluated in diabetic and non-diabetic patient groups with limb-threatening chronic leg ischemia after endovascular treatment, good clinical results were reported in these two groups. Current results suggest that endovascular treatment can be used safely and effectively in both patient groups.

Keywords

limb-threatening ischemia, endovascular intervention, diabetes mellitus

References

• 1. Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000. Circulation. 2004 Aug 10;110(6):738-43.
• 2. Pasternak RC, Criqui MH, Benjamin EJ, Fowkes FG, Isselbacher EM, McCullough PA, et al. American Heart Association. Atherosclerotic Vascular Disease Conference: Writing Group I: epidemiology. Circulation. 2004 Jun 1;109(21):2605-12.
• 3. Gregg EW, Sorlie P, Paulose-Ram R, Gu Q, Eberhardt MS, et al. 1999-2000 national health and nutrition examination survey. Prevalence of lower-extremity disease in the US adult population >=40 years of age with and without diabetes: 1999-2000 national health and nutrition examination survey. Diabetes Care. 2004 Jul;27(7):1591-7.
• 4. Norman PE, Davis WA, Bruce DG, Davis TM. Peripheral arterial disease and risk of cardiac death in type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care. 2006 Mar;29(3):575-80.
• 5. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007 Jan;45 Suppl S:S5-67.
• 6. Adam DJ, Bradbury AW. TASC II document on the management of peripheral arterial disease. Eur J Vasc Endovasc Surg. 2007 Jan;33(1):1-2.
• 7. Bosiers M, Hart JP, Deloose K, Verbist J, Peeters P. Endovascular therapy as the primary approach for limb salvage in patients with critical limb ischemia: experience with 443 infrapopliteal procedures. Vascular. 2006 Mar-Apr;14(2):63-9.
• 8. Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997 Sep;26(3):517-38. doi: 10.1016/s0741-5214(97)70045-4. Erratum in: J Vasc Surg 2001 Apr;33(4):805.
• 9. Feiring AJ, Krahn M, Nelson L, Wesolowski A, Eastwood D, Szabo A. Preventing leg amputations in critical limb ischemia with below-the-knee drug-eluting stents: the PaRADISE (PReventing Amputations using Drug eluting StEnts) trial. J Am Coll Cardiol. 2010 Apr 13;55(15):1580-9.
• 10. Romiti M, Albers M, Brochado-Neto FC, Durazzo AE, Pereira CA, De Luccia N. Meta-analysis of infrapopliteal angioplasty for chronic critical limb ischemia. J Vasc Surg. 2008 May;47(5):975-981.
• 11. O'Hare AM, Katz R, Shlipak MG, Cushman M, Newman AB. Mortality and cardiovascular risk across the ankle-arm index spectrum: results from the Cardiovascular Health Study. Circulation. 2006 Jan 24;113(3):388-93.
• 12. Ankle Brachial Index Collaboration, Fowkes FG, Murray GD, Butcher I, Heald CL, Lee RJ, et al. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA. 2008 Jul 9;300(2):197-208.
• 13. Coutinho T, Rooke TW, Kullo IJ. Arterial dysfunction and functional performance in patients with peripheral artery disease: a review. Vasc Med. 2011 Jun;16(3):203-11.
• 14. Englund EK, Langham MC, Ratcliffe SJ, Fanning MJ, Wehrli FW, Mohler ER 3rd, et al. Multiparametric assessment of vascular function in peripheral artery disease: dynamic measurement of skeletal muscle perfusion, blood-oxygen-level dependent signal, and venous oxygen saturation. Circ Cardiovasc Imaging. 2015 Apr;8(4): doi: 10.1161/CIRCIMAGING.114.002673 e002673.
• 15. Santos VPdA, Alves CAS, Fidelis Ronald José Ribeiro, Fidelis Cícero, Araújo Filho José Siqueira de. Estudo comparativo do Índice Tornozelo-Braquial em diabéticos e não diabéticos com isquemia crítica. J Vasc Bras. 2015 Dec;14(4):305-10.
• 16. Şırlak M, Kahraman D. Infrapoplıteal Angioplasty In Critical Limb Ischemia. Damar Cerrahi Dergisi.2016;25:11-6. doi: 10.9739/uvcd-51827.
• 17. Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg. 2000 Jan;31(1 Pt 2):S1-S296.
• 18. Hanna GP, Fujise K, Kjellgren O, Feld S, Fife C, Schroth G, et al. Infrapopliteal transcatheter interventions for limb salvage in diabetic patients: importance of aggressive interventional approach and role of transcutaneous oximetry. J Am Coll Cardiol. 1997 Sep;30(3):664-9.
• 19. Lee MS, Rha SW, Han SK, Choi BG, Choi SY, Ali J, et al. Comparison of diabetic and non-diabetic patients undergoing endovascular revascularization for peripheral arterial disease. J Invasive Cardiol. 2015 Mar;27(3):167-71.
• 20. American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care. 2003 Dec;26(12):3333-41.
• 21. Lévigne D, Tobalem M, Modarressi A, Pittet-Cuénod B. Hyperglycemia increases susceptibility to ischemic necrosis. Biomed Res Int. 2013;2013:490964.
• 22. Xiao L, Huang DS, Tong JJ, Shen J. Efficacy of endoluminal interventional therapy in diabetic peripheral arterial occlusive disease: a retrospective trial. Cardiovasc Diabetol. 2012 Feb 28;11:17.
• 23. Jude EB, Oyibo SO, Chalmers N, Boulton AJ. Peripheral arterial disease in diabetic and nondiabetic patients: a comparison of severity and outcome. Diabetes Care. 2001 Aug;24(8):1433-7.
• 24. Wolfe JH, Wyatt MG. Critical and subcritical ischaemia. Eur J Vasc Endovasc Surg. 1997 Jun;13(6):578-82.
• 25. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005 Jan 12;293(2):217-28.
• 26. Kawarada O, Fujihara M, Higashimori A, Yokoi Y, Honda Y, Fitzgerald PJ. Predictors of adverse clinical outcomes after successful infrapopliteal intervention. Catheter Cardiovasc Interv. 2012 Nov 1;80(5):861-71.
• 27. Rocha-Singh KJ, Jaff M, Joye J, Laird J, Ansel G, Schneider P; et al. Major adverse limb events and wound healing following infrapopliteal artery stent implantation in patients with critical limb ischemia: the XCELL trial. Catheter Cardiovasc Interv. 2012 Nov 15;80(6):1042-51.
• 28. Iida O, Nakamura M, Yamauchi Y, Kawasaki D, Yokoi Y, Yokoi H, et al. OLIVE Investigators. Endovascular treatment for infrainguinal vessels in patients with critical limb ischemia: OLIVE registry, a prospective, multicenter study in Japan with 12-month follow-up. Circ Cardiovasc Interv. 2013 Feb;6(1):68-76.