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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2004 March;11(1):35-9
Endovascular and surgical treatment of chronic limb ischaemia in diabetics
Losa S. 1, Ruscazio A. 1, Faglia E. 2, Mantero M. 2, Gabrielli L. 1
1 Department of Vascular Surgery Multimedica Polyclinic, Sesto S. Giovanni (MI), Italy
2 Department of Medicine Multimedica Polyclinic, Sesto S. Giovanni (MI), Italy
Aim. The presence of chronic limb ischaemia in diabetic patients is 4 times higher than in the normal population, with the risk of amputation 25% higher within 1 year. We examined the results of an aggressive attitude towards this disease, compared with a more conservative attitude found in the literature.
Methods. Between April and December 2000, we treated 50 diabetic patients with peripheral arteriopathy and distal trophic lesions (59 extremities treated); 38 endovascular procedures (36 tibial artery PTA; 1 popliteal artery and 1 superficial femoral artery PTA), 15 infragenicular bypasses (9 on the lower popliteal artery and 6 on the tibial arteries) and 5 femoral-popliteal-supragenicular bypasses. In 1 case we only carried out an exploration of the tibial arteries. Before revascularisation, surgical cleaning of the trophic lesions was carried out; a minor amputation was carried out 10-15 days later on average.
Results. Patients treated with tibial artery PTA were assessed by TcpO2 before and after treatment, and monitored clinically. Patients who underwent a surgical procedure were checked after 1, 2, 3, 6, 12 and 15 months by color Doppler scan and a clinical assessment. We considered limb salvage and healing of the trophic lesions as our primary end-point; our secondary end-points were patency in the bypass group and a TcpO2 increase in the tibial PTA group. Limb salvage, according to the Kaplan-Meier actuarial curve, was achieved in 89% of cases. The trophic lesions were healed in 37 out of 59 treated limbs; 6 cases underwent major amputation (3 thigh and 3 leg), 4 of which in the PTA group and 2 in the bypass group; 3 patients in the PTA group and 1 in the bypass group died as a result of other causes. Bypass patency 15 months later, according to the Kaplan-Meier curve, was 80% for supragenicular bypass and 69.2% for infragenicular. Mean TcpO2 before and after treatment increased from 22.37 (DS 12.78) to 49.21 (DS 16.83), (p=0).
Conclusion. In our experience distal endovascular procedures in the diabetic patient and/or surgical revascularisation allow us to obtain a high clinical success rate and to drastically reduce the major amputation rate.