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A 5-Year Follow-up Study to Assess Clinical Outcomes of Patients with Diabetes Undergoing Lower Limb Angiography for Significant Peripheral Artery Disease

INTRODUCTION: The optimal management for patients with diabetes and peripheral vascular disease—intermittent claudication or critical limb ischemia (CLI)—remains undetermined. METHODS: In a single-center retrospective analysis, we compared 1- and 5-year amputation-free survival rates in patients und...

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Autores principales: Gu, Yisu, Kokar, Chatchai, Gooday, Catherine, Morrow, Darren, Dhatariya, Ketan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Healthcare 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674466/
https://www.ncbi.nlm.nih.gov/pubmed/26386883
http://dx.doi.org/10.1007/s13300-015-0131-1
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author Gu, Yisu
Kokar, Chatchai
Gooday, Catherine
Morrow, Darren
Dhatariya, Ketan
author_facet Gu, Yisu
Kokar, Chatchai
Gooday, Catherine
Morrow, Darren
Dhatariya, Ketan
author_sort Gu, Yisu
collection PubMed
description INTRODUCTION: The optimal management for patients with diabetes and peripheral vascular disease—intermittent claudication or critical limb ischemia (CLI)—remains undetermined. METHODS: In a single-center retrospective analysis, we compared 1- and 5-year amputation-free survival rates in patients undergoing angiography subsequently treated with medical therapy or revascularization. RESULTS: 78 patients were included, 56 with CLI (mean age 77 years); 22 with claudication (mean age 75 years). Of the CLI cohort, 30 patients were medically treated. Their 1-year amputation-free survival rate was similar to those treated with revascularization (46.7% versus 50.0%, respectively). 8 patients in the claudicant cohort were treated conservatively. The 1-year amputation-free survival rate was 75.0% for conservative treatment versus 78.6% in those revascularized. Within the CLI cohort, in those conservatively treated 20% underwent major, and 16.7% minor amputations, compared to 15.4% and 23.1% in those revascularized. At 5 years in the claudicant cohort, the amputation-free survival rate was 37.5% with medical treatment, versus 71.4% for those treated with revascularization. For CLI, the 5-year amputation-free survival rate was 10% for conservative treatment, versus 26.9% for revascularization. CONCLUSION: We found similar rates of amputation at 1 year for patients treated medically or revascularized. However, at 5 years, the amputation-free survival rate was markedly higher in revascularized patients compared to those medically managed. Our study highlights the potential role of predicting life expectancy when considering treatment, with the option of surgical treatment offered to those in whom survival is predicted to be longer than 5 years. However, larger studies with matched cohorts are now needed to confirm these findings. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13300-015-0131-1) contains supplementary material, which is available to authorized users.
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spelling pubmed-46744662015-12-17 A 5-Year Follow-up Study to Assess Clinical Outcomes of Patients with Diabetes Undergoing Lower Limb Angiography for Significant Peripheral Artery Disease Gu, Yisu Kokar, Chatchai Gooday, Catherine Morrow, Darren Dhatariya, Ketan Diabetes Ther Original Research INTRODUCTION: The optimal management for patients with diabetes and peripheral vascular disease—intermittent claudication or critical limb ischemia (CLI)—remains undetermined. METHODS: In a single-center retrospective analysis, we compared 1- and 5-year amputation-free survival rates in patients undergoing angiography subsequently treated with medical therapy or revascularization. RESULTS: 78 patients were included, 56 with CLI (mean age 77 years); 22 with claudication (mean age 75 years). Of the CLI cohort, 30 patients were medically treated. Their 1-year amputation-free survival rate was similar to those treated with revascularization (46.7% versus 50.0%, respectively). 8 patients in the claudicant cohort were treated conservatively. The 1-year amputation-free survival rate was 75.0% for conservative treatment versus 78.6% in those revascularized. Within the CLI cohort, in those conservatively treated 20% underwent major, and 16.7% minor amputations, compared to 15.4% and 23.1% in those revascularized. At 5 years in the claudicant cohort, the amputation-free survival rate was 37.5% with medical treatment, versus 71.4% for those treated with revascularization. For CLI, the 5-year amputation-free survival rate was 10% for conservative treatment, versus 26.9% for revascularization. CONCLUSION: We found similar rates of amputation at 1 year for patients treated medically or revascularized. However, at 5 years, the amputation-free survival rate was markedly higher in revascularized patients compared to those medically managed. Our study highlights the potential role of predicting life expectancy when considering treatment, with the option of surgical treatment offered to those in whom survival is predicted to be longer than 5 years. However, larger studies with matched cohorts are now needed to confirm these findings. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13300-015-0131-1) contains supplementary material, which is available to authorized users. Springer Healthcare 2015-09-19 2015-12 /pmc/articles/PMC4674466/ /pubmed/26386883 http://dx.doi.org/10.1007/s13300-015-0131-1 Text en © The Author(s) 2015 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Research
Gu, Yisu
Kokar, Chatchai
Gooday, Catherine
Morrow, Darren
Dhatariya, Ketan
A 5-Year Follow-up Study to Assess Clinical Outcomes of Patients with Diabetes Undergoing Lower Limb Angiography for Significant Peripheral Artery Disease
title A 5-Year Follow-up Study to Assess Clinical Outcomes of Patients with Diabetes Undergoing Lower Limb Angiography for Significant Peripheral Artery Disease
title_full A 5-Year Follow-up Study to Assess Clinical Outcomes of Patients with Diabetes Undergoing Lower Limb Angiography for Significant Peripheral Artery Disease
title_fullStr A 5-Year Follow-up Study to Assess Clinical Outcomes of Patients with Diabetes Undergoing Lower Limb Angiography for Significant Peripheral Artery Disease
title_full_unstemmed A 5-Year Follow-up Study to Assess Clinical Outcomes of Patients with Diabetes Undergoing Lower Limb Angiography for Significant Peripheral Artery Disease
title_short A 5-Year Follow-up Study to Assess Clinical Outcomes of Patients with Diabetes Undergoing Lower Limb Angiography for Significant Peripheral Artery Disease
title_sort 5-year follow-up study to assess clinical outcomes of patients with diabetes undergoing lower limb angiography for significant peripheral artery disease
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674466/
https://www.ncbi.nlm.nih.gov/pubmed/26386883
http://dx.doi.org/10.1007/s13300-015-0131-1
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