Print this page2007 Abstracts: Impact of Diabetes Mellitus on the Long Term Outcomes of Superficial Femoral Artery Endoluminal Interventions
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Andrew M Bakken*, Eugene Palchik*, Wael E Saad, Joseph P Hart, Michael J Singh, Jeffrey M Rhodes, Karl A Illig, James A Deweese, David L Waldman, Mark G Davies*
University of Rochester, Rochester, NY
Background: While aggressive endoluminal therapy for superficial femoral artery (SFA) occlusive disease is commonplace, the implications of diabetes mellitus on long-term outcomes in this population are unclear. We examined the consequences of endovascular treatment of the SFA in patients with diabetes mellitus (DM).
Methods: A prospective database of patients undergoing endovascular treatment of the SFA between 1986 and 2005 was maintained. Diabetes was defined as a fasting plasma glucose >110 mg/dL or a HbA1c >7%. Three groups were defined: no DM, non-insulin dependent DM (NIDDM) and insulin dependent DM (IDDM). Intention to treat analysis was performed. Results were standardized to current TransAtlantic Inter-Society Consensus (TASC) and SVS criteria. Kaplan-Meier survival analyses were performed to assess time-dependent outcomes. Factor analyses were performed using a Cox proportional hazard model for time dependent variables. Data are presented as mean ± SEM.
Results: 550 limbs in 466 patients (69% male, average age 66 years) underwent endovascular treatment for chronic critical ischemia. 50% had no DM, 26% had NIDDM and 24% had IDDM. The groups had comparable symptoms grades and tibial vessel runoff. Overall mortality was 1.5% and overall morbidity was 18% at 90 days after the procedure. No specific lesion characteristics or procedural events were identified that would predict failure. The characteristics and outcomes in the three groups are shown in the table. Progression of distal tibial vessel athero-occlusive disease was seen in 4% of no DM and NIDDM and 8% of IDDM patients.
| No DM | NIDDM | IDDM | p-value | |
| Median SVS Symptom Grade | 3 | 4 | 4 | ns |
| Lesion Category TASC A/B | 83% | 50%* | 74% | p < 0.05 |
| Lesion Category TASC C/D | 17% | 50%* | 26% | p < 0.05 |
| Tibial vessel runoff (0,1,2,3) | 2 | 2 | 2 | ns |
| Mortality | 1.5% | 1.5% | 1.6% | ns |
| Morbidity | 19% | 19% | 16% | ns |
| Technical Failures | 7% | 7% | 6% | ns |
| Cumulative Patency at 5 yrs | 46±8% | 46±9% | 40±9% | ns |
| Freedom from Recurrent symptoms at 5 yrs | 68±10% | 59±10% | 50±5%* | p < 0.05 |
| Limb salvage | 90±4% | 82±10% | 58±10%* | p < 0.05 |
Conclusions: Endoluminal therapy for SFA disease in both categories of DM has equivalent cumulative patency to no DM. However, freedom from recurrent symptoms and limb salvage is worse in patients with IDDM compared to either no DM or NIDDM groups and this is due to progression of distal disease Endoluminal revascularization of SFA disease in DM is durable but these patients suffer symptomatic and functional impairment from progression of their distal disease in the long term.
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