Background: Diabetics with peripheral arterial disease (PAD), mainly below-the knee (BTK) lesions, are known to have higher risk for mortality and cardiovascular events, but long-term clinical outcomes are unknown.
Methods: A total of 765 consecutive patients (pts) with significant PAD underwent endovascular therapy (EVT). DM group (560 pts & 711 limbs) and non-DM group (205 pts & 257 limbs) were compared by a variety of clinical data, coronary and peripheral angiographic characteristics including lesion distribution, Rutherford classification, previous surgical treatment, and post-procedural complications. To adjust for any potential confounders, propensity score matching (PSM) analysis including lesion location was performed. Major clinical outcomes and limb events were assessed by Kaplan-Meier analysis for up to 5 years.
Results: At baseline, the DM group had more femoral and BTK lesions and fewer distal aorta, iliac and popliteal arterial lesions. The DM group showed multiple high-risk clinical features and a higher rate of major adverse limb events (MALEs), largely due to a higher rate of below the ankle amputations (Table). After PSM analysis, 2 well balanced groups (120 pairs) were generated. Clinical follow-up of 5 years revealed no difference between the two groups including mortality, myocardial infarction, stroke, peripheral revascularization, and target extremity surgery except a higher trend for coronary revascularization and less hemorrhagic stroke in the DM group.
Conclusion: Higher rate of BTA amputation in diabetics may be attributed to the peripheral distribution of advanced lower extremity lesions, particularly in below-the knee and below-the ankle in DM patients. After matching for lesion distribution, the diabetic group did not show worse long-term clinical outcomes compared with non-DM patients following aggressive EVT with optimal medical therapy.