ENDOVASCULAR REVASCULARIZATION OUTCOMES IN PERIPHERAL ARTERIAL DISEASE PATIENTS WITH TYPE-II DIABETES MELLITUS
Abstract
Introduction: Type 2 diabetes mellitus is a strong predisposing factor for peripheral arterial disease, it is also a significant risk factor for endovascular revascularization treatment success. Patient selection is critical in endovascular revascularization for patients with type 2 diabetes mellitus.
Methods: Fifty-seven patients with type 2 diabetes mellitus underwent endovascular lower limb revascularization. The follow-up time was 6 months and the outcomes were recorded two times in one and six months after the procedure. Multivariate analysis was run to determine independent factors that related to target vessel restenosis.
Results: Mean age of the study cohort was 66.5 years and 21.2% of patients were female. The smoking rate was 59.6%. Sixteen patients underwent stent angioplasty and forty-one patients underwent balloon angioplasty. 1-month and 6-month patent target vessel rates were found 93% and 64.9% respectively. Multivariate analysis showed that smoking is a negative indicator, and balloon angioplasty and insulin- based therapy are positive indicators for endovascular revascularization outcomes in patients with type 2 diabetes mellitus.
Conclusion: Endovascular revascularization is a promising option for peripheral arterial disease patients with type 2 diabetes. However, actively smoking and stenting may be risk factors for endovascular treatment success and insulin-based therapy and balloon angioplasty related to improved outcomes.
References
- 1. Aday AW, Matsushita K. Epidemiology of peripheral artery disease and polyvascular disease. Circulation research. 2021; 128:1818-32.
- 2. Pan Y, Luo Y, Hong J, et al. Advances for the treatment of lower extremity arterial disease associated with diabetes mellitus. Front Mol Biosci. 2022; 9: 929718.
- 3. Mohammedi K, Woodward M, Hirakawa Y, et al. Presentations of major peripheral arterial disease and risk of major outcomes in patients with type 2 diabetes: results from the ADVANCE-ON study. Cardiovasc Diabetol. 2016; 15: 129.
- 4. Nativel M, Potier L, Alexandre L, et al. Lower extremity arterial disease in patients with diabetes: a contemporary narrative review. Cardiovasc Diabetol. 2018; 17: 138.
- 5. Guariguata L, Whiting DR, Hambleton I, et al. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014; 103:137-49.
- 6. Buso G, Aboyans V, Mazzolai L. Lower extremity artery disease in patients with type 2 diabetes. Eur J Prev Cardiol. 2019; 26: 114-24.
- 7. Chow CY, Mathlouthi A, Zarrintan S, Swafford EP, Siracuse JJ, Malas MB. Outcomes of elective peripheral endovascular interventions for peripheral arterial disease performed in hospital outpatient departments, ambulatory surgical centers and office-based labs. J Vasc Surg. 2023; S0741-5214(23)00274-4.
- 8. Lee RE, Patel A, Soon SXY, et al. One year clinical outcomes of Rutherford 6 chronic limb threatening ischemia patients undergoing lower limb endovascular revascularisation from Singapore. CVIR Endovasc. 2022; 5: 32.
- 9. Song P, Rudan D, Zhu Y, et al. Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis. Lancet Glob Health. 2019; 7: e1020-e1030.
- 10. Holman RR, Paul SK, Bethel MA, et al. 10-Year followup of intensive glucose control in type 2 diabetes. N Engl J Med 2008; 359: 1577–1589.
- 11. Marmagkiolis K, Kilic ID, Inanc IH, Iliescu C, Ajmal M, Cilingiroglu M. Superficial Femoral Artery Endovascular Therapy: 12-Month Primary Patency Rates of Contemporary Endovascular Devices from 25,051 Patients. J Invasive Cardiol. 2022; 34: E784-E792.
- 12. Giannopoulos S, Volteas P, Virvilis D. Specialty Balloons for Vessel Preparation During Infrainguinal Endovascular Revascularization Procedures: A Review of Literature. Vasc Endovascular Surg. 2023; 57: 599-606.
- 13. Yang J, Yue J, Chen X, et al. Safety and Efficacy of the Passeo-18 Lux Drug-Coated Balloon Catheter in Atherosclerotic Femoropopliteal Lesions: The Multicenter BIOLUX P-IV China Study [published online ahead of print, 2023 Feb 14]. Ann Vasc Surg. 2023; 93: 275-82.
- 14. Gebreyohannes EA, Netere AK, Belachew SA. Glycemic control among diabetic patients in Ethiopia: A systematic review and meta-analysis. PLoS One. 2019;14: e0221790.
- 15. Nagrebetsky A, Griffin S, Kinmonth AL, et al. Predictors of suboptimal glycaemic control in type 2 diabetes patients: the role of medication adherence and body mass index in the relationship between glycaemia and age. Diabetes Res Clin Pract. 2012; 96: 119-28.
- 16. Khattab M, Khader YS, Al-Khawaldeh A, Ajlouni K. Factors associated with poor glycemic control among patients with type 2 diabetes. J Diabetes Complications. 2010; 24: 84-9.
- 17. American Diabetes Association. Standards of Medical Care in Diabetes-2019 Abridged for Primary Care Providers. Clin Diabetes. 2019; 37: 11-34.
- 18. Kastrati A, Mehilli J, von Beckerath N, et al. Sirolimus-eluting stent or paclitaxel-eluting stent vs balloon angioplasty for prevention of recurrences in patients with coronary in-stent restenosis: a randomized controlled trial. Jama. 2005; 293: 165-71.
- 19. Kaya IÇ, Kaya FA. Radiation doses in endovascular revascularisation of lower-extremity arterial diseases. Cardiovasc J Afr. 2022; 33: 1-5.
- 20. Tan M, Takahara M, Soga Y, et al. Three-Year Clinical Outcomes Following Implantation of LifeStent Self-Expanding Nitinol Stents in Patients with Femoropopliteal Artery Lesions. Angiology. 2022; 73: 244-51.
- 21. Ouriel K, Adelman MA, Rosenfield K, et al. Safety of paclitaxel-coated balloon angioplasty for femoropopliteal peripheral artery disease. JACC: Cardiovascular Interventions, 2019: 12; 2515-24.
- 22. Scheinert D, Katsanos K, Zeller T, et al. A prospective randomized multicenter comparison of balloon angioplasty and infrapopliteal stenting with the sirolimus-eluting stent in patients with ischemic peripheral arterial disease: 1-year results from the ACHILLES trial. Journal of the American College of Cardiology. 2012: 60; 2290-95.
- 23. Tsujimura T, Takahara M, Iida O, et al. One-Year Clinical Outcomes following Implantation of InnovaTM Self-Expanding Nitinol Stents in Patients with Peripheral Artery Diseases Presenting Femoropopliteal Artery Lesions. J Atheroscler Thromb. 2019; 26: 847-55.
- 24. Chen S L, Whealon MD, Kabutey NK, Kuo IJ, Sgroi MD, Fujitani RM. Outcomes of open and endovascular lower extremity revascularization in active smokers with advanced peripheral arterial disease. Journal of Vascular Surgery 2017: 65, 1680-89.
- 25. Rosenfield K, Jaff MR, White CJ, et al. Trial of a paclitaxelcoated balloon for femoropopliteal artery disease. N Engl J Med 2015; 373: 145–53.
Abstract
Giriş: Tip 2 diabetes mellitus, periferik arter hastalığı için güçlü bir predispozan faktör ve aynı zamanda endovasküler revaskülarizasyon tedavisinin başarısı için önemli bir risk faktörüdür. Tip 2 diabetes mellituslu hastalarda endovasküler revaskülarizasyonda hasta seçimi çok önemlidir.
Yöntemler: Tip 2 diabetes mellitus tanılı elli yedi hastaya endovasküler alt ekstremite revaskülarizasyonu uygulandı. Takip süresi 6 aydı ve sonuçlar işlem sonrası bir ve altı ayda iki kez kaydedildi.Hedef damar restenozu ile ilgili bağımsız faktörleri belirlemek için çok değişkenli analiz yapıldı.
Bulgular: Çalışma grubunun yaş ortalaması 66,5 yaş olup hastaların %21,2'si kadındı. Sigara içme oranı %59,6 idi. On altı hastaya stent anjiyoplasti ve kırk bir hastaya balon anjiyoplasti uygulandı. 1 aylık ve 6 aylık hedef damar açıklık oranları sırasıyla %93 ve %64,9 bulundu. Çok değişkenli analiz, tip 2 diabetes mellituslu hastalarda endovasküler revaskülarizasyon sonuçları için sigara içmenin negatif bir gösterge olduğunu ve balon anjiyoplasti ve insülin bazlı tedavinin pozitif göstergeler olduğunu gösterdi.
Sonuç: Endovasküler revaskülarizasyon, tip 2 diyabetli periferik arter hastalığı olan hastalar için umut verici bir seçenektir. Bununla birlikte, aktif olarak sigara içmek ve stent anjioplasti, endovasküler tedavi başarısı için risk faktörleridir ve insülin bazlı tedavi ve balon anjiyoplasti, daha iyi sonuçlarla ilişkilidir.
References
- 1. Aday AW, Matsushita K. Epidemiology of peripheral artery disease and polyvascular disease. Circulation research. 2021; 128:1818-32.
- 2. Pan Y, Luo Y, Hong J, et al. Advances for the treatment of lower extremity arterial disease associated with diabetes mellitus. Front Mol Biosci. 2022; 9: 929718.
- 3. Mohammedi K, Woodward M, Hirakawa Y, et al. Presentations of major peripheral arterial disease and risk of major outcomes in patients with type 2 diabetes: results from the ADVANCE-ON study. Cardiovasc Diabetol. 2016; 15: 129.
- 4. Nativel M, Potier L, Alexandre L, et al. Lower extremity arterial disease in patients with diabetes: a contemporary narrative review. Cardiovasc Diabetol. 2018; 17: 138.
- 5. Guariguata L, Whiting DR, Hambleton I, et al. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014; 103:137-49.
- 6. Buso G, Aboyans V, Mazzolai L. Lower extremity artery disease in patients with type 2 diabetes. Eur J Prev Cardiol. 2019; 26: 114-24.
- 7. Chow CY, Mathlouthi A, Zarrintan S, Swafford EP, Siracuse JJ, Malas MB. Outcomes of elective peripheral endovascular interventions for peripheral arterial disease performed in hospital outpatient departments, ambulatory surgical centers and office-based labs. J Vasc Surg. 2023; S0741-5214(23)00274-4.
- 8. Lee RE, Patel A, Soon SXY, et al. One year clinical outcomes of Rutherford 6 chronic limb threatening ischemia patients undergoing lower limb endovascular revascularisation from Singapore. CVIR Endovasc. 2022; 5: 32.
- 9. Song P, Rudan D, Zhu Y, et al. Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis. Lancet Glob Health. 2019; 7: e1020-e1030.
- 10. Holman RR, Paul SK, Bethel MA, et al. 10-Year followup of intensive glucose control in type 2 diabetes. N Engl J Med 2008; 359: 1577–1589.
- 11. Marmagkiolis K, Kilic ID, Inanc IH, Iliescu C, Ajmal M, Cilingiroglu M. Superficial Femoral Artery Endovascular Therapy: 12-Month Primary Patency Rates of Contemporary Endovascular Devices from 25,051 Patients. J Invasive Cardiol. 2022; 34: E784-E792.
- 12. Giannopoulos S, Volteas P, Virvilis D. Specialty Balloons for Vessel Preparation During Infrainguinal Endovascular Revascularization Procedures: A Review of Literature. Vasc Endovascular Surg. 2023; 57: 599-606.
- 13. Yang J, Yue J, Chen X, et al. Safety and Efficacy of the Passeo-18 Lux Drug-Coated Balloon Catheter in Atherosclerotic Femoropopliteal Lesions: The Multicenter BIOLUX P-IV China Study [published online ahead of print, 2023 Feb 14]. Ann Vasc Surg. 2023; 93: 275-82.
- 14. Gebreyohannes EA, Netere AK, Belachew SA. Glycemic control among diabetic patients in Ethiopia: A systematic review and meta-analysis. PLoS One. 2019;14: e0221790.
- 15. Nagrebetsky A, Griffin S, Kinmonth AL, et al. Predictors of suboptimal glycaemic control in type 2 diabetes patients: the role of medication adherence and body mass index in the relationship between glycaemia and age. Diabetes Res Clin Pract. 2012; 96: 119-28.
- 16. Khattab M, Khader YS, Al-Khawaldeh A, Ajlouni K. Factors associated with poor glycemic control among patients with type 2 diabetes. J Diabetes Complications. 2010; 24: 84-9.
- 17. American Diabetes Association. Standards of Medical Care in Diabetes-2019 Abridged for Primary Care Providers. Clin Diabetes. 2019; 37: 11-34.
- 18. Kastrati A, Mehilli J, von Beckerath N, et al. Sirolimus-eluting stent or paclitaxel-eluting stent vs balloon angioplasty for prevention of recurrences in patients with coronary in-stent restenosis: a randomized controlled trial. Jama. 2005; 293: 165-71.
- 19. Kaya IÇ, Kaya FA. Radiation doses in endovascular revascularisation of lower-extremity arterial diseases. Cardiovasc J Afr. 2022; 33: 1-5.
- 20. Tan M, Takahara M, Soga Y, et al. Three-Year Clinical Outcomes Following Implantation of LifeStent Self-Expanding Nitinol Stents in Patients with Femoropopliteal Artery Lesions. Angiology. 2022; 73: 244-51.
- 21. Ouriel K, Adelman MA, Rosenfield K, et al. Safety of paclitaxel-coated balloon angioplasty for femoropopliteal peripheral artery disease. JACC: Cardiovascular Interventions, 2019: 12; 2515-24.
- 22. Scheinert D, Katsanos K, Zeller T, et al. A prospective randomized multicenter comparison of balloon angioplasty and infrapopliteal stenting with the sirolimus-eluting stent in patients with ischemic peripheral arterial disease: 1-year results from the ACHILLES trial. Journal of the American College of Cardiology. 2012: 60; 2290-95.
- 23. Tsujimura T, Takahara M, Iida O, et al. One-Year Clinical Outcomes following Implantation of InnovaTM Self-Expanding Nitinol Stents in Patients with Peripheral Artery Diseases Presenting Femoropopliteal Artery Lesions. J Atheroscler Thromb. 2019; 26: 847-55.
- 24. Chen S L, Whealon MD, Kabutey NK, Kuo IJ, Sgroi MD, Fujitani RM. Outcomes of open and endovascular lower extremity revascularization in active smokers with advanced peripheral arterial disease. Journal of Vascular Surgery 2017: 65, 1680-89.
- 25. Rosenfield K, Jaff MR, White CJ, et al. Trial of a paclitaxelcoated balloon for femoropopliteal artery disease. N Engl J Med 2015; 373: 145–53.
Details
| Primary Language | English |
|---|---|
| Subjects | Cardiovascular Surgery, Cardiology |
| Journal Section | Research Articles |
| Authors | |
| Early Pub Date | October 16, 2023 |
| Publication Date | October 16, 2023 |
| Published in Issue | Year 2023 Volume: 4 Issue: Ek Sayı |
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