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Diabetes mellitus was not associated with lower amputation-free survival after open revascularization for chronic limb-threatening ischemia : A nationwide propensity score adjusted analysis

Lilja, Erika LU orcid ; Gottsäter, Anders LU ; Miftaraj, Mervete ; Ekelund, Jan ; Eliasson, Björn ; Svensson, Ann-Marie ; Zarrouk, Moncef LU and Acosta, Stefan LU orcid (2021) In Vascular Medicine 26(5). p.507-514
Abstract

The risk of major amputation is higher after urgently planned endovascular therapy for chronic limb-threatening ischemia (CLTI) in patients with diabetes mellitus (DM). The aim of this nationwide cohort study was to compare outcomes between patients with and without DM following urgently planned open revascularization for CLTI from 2010 to 2014. Out of 1537 individuals registered in the Swedish Vascular Registry, 569 were registered in the National Diabetes Register. A propensity score adjusted Cox regression analysis was conducted to compare outcome between the groups with and without DM. Median follow-up was 4.3 years and 4.5 years for patients with and without DM, respectively. Patients with DM more often had foot ulcers (p = 0.034)... (More)

The risk of major amputation is higher after urgently planned endovascular therapy for chronic limb-threatening ischemia (CLTI) in patients with diabetes mellitus (DM). The aim of this nationwide cohort study was to compare outcomes between patients with and without DM following urgently planned open revascularization for CLTI from 2010 to 2014. Out of 1537 individuals registered in the Swedish Vascular Registry, 569 were registered in the National Diabetes Register. A propensity score adjusted Cox regression analysis was conducted to compare outcome between the groups with and without DM. Median follow-up was 4.3 years and 4.5 years for patients with and without DM, respectively. Patients with DM more often had foot ulcers (p = 0.034) and had undergone more previous amputations (p = 0.001) at baseline. No differences in mortality, cardiovascular death, major adverse cardiovascular events (MACE), or major amputation were observed between groups. The incidence rate of stroke was 70% higher (95% CI: 1.11-2.59; p = 0.0137) and the incidence rate of acute myocardial infarction (AMI) 39% higher (95% CI: 1.00-1.92; p = 0.0472) among patients with DM in comparison to those without. Open vascular surgery remains a first-line option for a substantial number of patients with CLTI, especially for limb salvage in patients with DM. The higher incidence rates of stroke and AMI among patients with DM following open vascular surgery for infrainguinal CLTI require specific consideration preoperatively with the aim of optimizing medical treatment to improve cardiovascular outcome postoperatively.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
amputation, bypass, chronic limb-threatening ischemia (CLTI), diabetes mellitus
in
Vascular Medicine
volume
26
issue
5
pages
507 - 514
publisher
SAGE Publications
external identifiers
  • pmid:34004125
  • scopus:85106313920
ISSN
1477-0377
DOI
10.1177/1358863X211008249
language
English
LU publication?
yes
id
5f5dad40-dd99-4704-85cd-ba43dbed3bb9
date added to LUP
2021-05-27 10:04:42
date last changed
2024-04-06 04:11:44
@article{5f5dad40-dd99-4704-85cd-ba43dbed3bb9,
  abstract     = {{<p>The risk of major amputation is higher after urgently planned endovascular therapy for chronic limb-threatening ischemia (CLTI) in patients with diabetes mellitus (DM). The aim of this nationwide cohort study was to compare outcomes between patients with and without DM following urgently planned open revascularization for CLTI from 2010 to 2014. Out of 1537 individuals registered in the Swedish Vascular Registry, 569 were registered in the National Diabetes Register. A propensity score adjusted Cox regression analysis was conducted to compare outcome between the groups with and without DM. Median follow-up was 4.3 years and 4.5 years for patients with and without DM, respectively. Patients with DM more often had foot ulcers (p = 0.034) and had undergone more previous amputations (p = 0.001) at baseline. No differences in mortality, cardiovascular death, major adverse cardiovascular events (MACE), or major amputation were observed between groups. The incidence rate of stroke was 70% higher (95% CI: 1.11-2.59; p = 0.0137) and the incidence rate of acute myocardial infarction (AMI) 39% higher (95% CI: 1.00-1.92; p = 0.0472) among patients with DM in comparison to those without. Open vascular surgery remains a first-line option for a substantial number of patients with CLTI, especially for limb salvage in patients with DM. The higher incidence rates of stroke and AMI among patients with DM following open vascular surgery for infrainguinal CLTI require specific consideration preoperatively with the aim of optimizing medical treatment to improve cardiovascular outcome postoperatively.</p>}},
  author       = {{Lilja, Erika and Gottsäter, Anders and Miftaraj, Mervete and Ekelund, Jan and Eliasson, Björn and Svensson, Ann-Marie and Zarrouk, Moncef and Acosta, Stefan}},
  issn         = {{1477-0377}},
  keywords     = {{amputation; bypass; chronic limb-threatening ischemia (CLTI); diabetes mellitus}},
  language     = {{eng}},
  month        = {{05}},
  number       = {{5}},
  pages        = {{507--514}},
  publisher    = {{SAGE Publications}},
  series       = {{Vascular Medicine}},
  title        = {{Diabetes mellitus was not associated with lower amputation-free survival after open revascularization for chronic limb-threatening ischemia : A nationwide propensity score adjusted analysis}},
  url          = {{http://dx.doi.org/10.1177/1358863X211008249}},
  doi          = {{10.1177/1358863X211008249}},
  volume       = {{26}},
  year         = {{2021}},
}