VolumeVol. 53 • Number No. 2 • April - June 2015 Back

Case Report

​​​​​​​Long Term Outcome of Type 2 Diabetic Patients With Critical Limb Ischemia

Authors: Danny Joseph Tuazon, Ma. Teresa Plata-Que

DOI: 10.65564/pjim.118ac51d3e

Date of Publication: June 2015


Abstract

Introduction: Diabetes Mellitus is associated with vascular disease. One of its macrovascular complications is peripheral arterial disease (PAD), which can present as critical limb ischemia (CLI) that can eventually lead to amputation and death.

Objective: Determine the long-term outcome of Type 2 diabetic patients with critical limb ischemia in National Kidney and Transplant Institute (NKTI).

Methods: Computerized search of NKTI Medical Records Section was done using the Docuview. Type 2 diabetic patients with critical limb ischemia of the lower extremities were included in the study. Patients were grouped according to the intervention received (No intervention, Bypass Graft or Peripheral Angioplasty). Endpoints such as amputation and mortality were ascertained on readmissions and on outpatient records. Data processing and analyses were performed using SPSS v20. Kaplan-Meier Survival Analysis was used to examine days to amputation and days to mortality between groups.

Results: Twenty-three (23) patients were included in the study. There was no significant difference on the baseline characteristics of those who received revascularization and those who did not have revascularization. Amputation rate was 31% while mortality rate was 30% for the whole population. Patients who had revascularization seemed to have greater probability of amputation and lesser probability of dying, but these were not statistically significant based on Kaplan - Meier Survival Curves p values of 0.918 and 0.433, respectively.

Conclusion: Diabetic patients with CLI still carries a high risk of amputation and mortality even with revascularization but the time to amputation is longer for those who were revascularized.

Keywords: critical limb ischemia, bypass graft, angioplasty, amputation, mortality


References

  1. Cefalu W. Standard of Medical Care in Diabetes. Diabetes Care 2013; 36: Supp 1.
  2. Faglia E, Clerici G, Clerissi J, et al. Long-Term Prognosis of Diabetic Patients With Critical Limb Ischemia. Diabetes Care 2009; 32: 822-827.
  3. Wietz J, Byrne J, Clagett P, et al. Diagnosis and Treatment of Chronic Arterial Insufficiency of the Lower Extremities: A Critical review. Circulation 1996; 94: 3026-3049.
  4. Norgren L, Hiatt W, Dormandy J, et al. Trans-Atlantic Inter-Society Concensus Document on Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg 2007.
  5. Carbayo J, Divison J, Escribano J, et al. Using ankle-brachial index to detect peripheral arterial disease: Prevalence and associated risk factors in a random population sample. Nutrition, Metabolism & Cardiovascular Diseases, Elsevier 2007; 17: 41-49.
  6. Kownator S, Cabmou J, Cacoub P, et al. Prevalence of unknown peripheral arterial disease in patients with coronary artery disease: Data in primary care from the IPSILON study. Archive of Cardiovascular Disease, Elsevier Masson 2009; 102: 625-631.
  7. Escobar C, Blanes I, Ruiz A, et al. Prevalence and clinical profile and management of peripheral arterial disease in elderly patients with diabetes. European Journal of Internal Medicine, Elsevier 2011; 22: 275-281.
  8. Heulmos A, Jimenez J, Guijarro C, et al. Underrecognized Peripheral Arterial Disease in Patients With Acute Coronary Syndrome: Prevalence of Traditional and Emergent Cardiovascular Risk Factors. Revista Espanola de Cardiologia 2005; 58: 1403-1410.
  9. Bianchi C, Penno G, Pancani F, et al. Non-traditional cardiovascular risk factors contribute to peripheral arterial disease in patients with type 2 diabetes. Diabetes Research and Clinical Practice, Elsevier 2007;78: 246-253.
  10. Maeda Y, Inoguchi T, Tsubouchi H, et al. High prevalence of peripheral arterial disease diagnosed by low ankle-brachial index in Japanese patients with diabetes: The Kyushu Prevention Study for Atherosclerosis. Diabetes Research and Clinical Practice, Elsevier 2008; 82: 378- 382.
  11. Wattanakit K, Folsom A, Selvin E, et al. Risk Factors for peripheral arterial disease incidence in person with diabetes: the Atherosclerosis Risk in Communities (ARIC) Study. Atheroclerosis, Elsevier 2005;180: 389-397.
  12. Tapp R, Balkau B, Shaw J, Valensi P, Cailleau M, Eschwege E. Association of glucose metabolism, smoking and cardiovascular risk factors with incident peripheral arterial disease: The DESIR study. Atherosclerosis, Elsevier 2007; 190: 84-89.
  13. Feringa H, Van Waning V, Bax J, et al. Cardioprotective Medication Is Associated With Improved Survival in Patients With Peripheral Arterial Disease. Vascular Disease, Journal of the American College of Cardiology, Elsevier 2006 Vol 47; 6: 1182-1187.
  14. Chou C, Weng S, Chang H, Chen C, Su S, Liu R. Analysis of traditional and nontraditional risk factors for peripheral arterial disease in elderly type 2 diabetic patients in Taiwan. Diabetes Research and Clinical Practice, Elsevier 2008; 81: 331-337.
  15. Quiles J, Morillas P, Bertomeu V, et al. Combination of ankle brachial index and diabetes mellitus to predict cardiovascular events and mortality after an acute coronary syndrome. International Journal of Cardiology, Elsevier 2011; 151: 84-88.
  16. Rhee S, Guan H, Liu Z, et al. Multi-country study on the prevalence and clinical features of peripheral arterial disease in Asian type 2 diabetes patients at high risk of atherosclerosis. Diabetes Research and Clinical Practice, Elsevier 2007: 82-92.
  17. Yang X, Sun K, Zhang W, Wu H, Zhang H, Hui R. Prevalence of and risk factors for peripheral arterial disease in the patients with hypertension among Han Chinese. Journal of Vascular Surgery 2007, Vol 46; 2: 296-302.
  18. Aronow W, Ahn C, Weiss M, Babu S. Relation of Increased of Hemoglobin A1c Levels to Severity of Peripheral Arterial Disease in Patients With Diabetes Mellitus. American Journal of Cardiology, Elsevier 2007; 99: 1468-1469.
  19. Choi S, Shin M, Yun W, et al. Association between hemoglobin A1c, carotid atherosclerosis, arterial stiffness, and peripheral arterial disease in Korean type 2 diabetic patients. Journal of Diabetes and Its Complications, Elsevier 2011: 7-13.
  20. Cassar K, Bachoo P, Ford I, Greaves M, Brittenden J. Markers of Coagulation Activation, Endothelia Stimualtion and Inflammation in Patients with Peripheral Arterial Disease. European Journal of Vascular and Endovascular Surgery, Elsevier 2005; 29: 171-176.
  21. Kudoh T, Sakamoto T, Miyamoto S, et al. Relation between platelet microaggregates and ankle brachial index in patients with peripheral arterial disease. Thrombosis Research, Elsevier 2006; 117: 263-269.
  22. Bradbury A, Adam D, Bell L, et al. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL): A survival prediction model to facilitate clinical decision making. Journal of Vascular Surgery 2010.