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Comparison of Outcomes After Revascularization for Acute Lower Limb Ischemia in Patients with and without Type 2 Diabetes Mellitus – A Nationwide Registry Study

Karonen, Emil LU orcid ; Eek, Frida LU orcid ; Drake, Isabel LU ; Gottsäter, Anders LU ; Acosta, Stefan LU orcid ; Butt, Talha LU ; Carlsen, Hanne Krage and Eliasson, Björn (2025) In Vascular Health and Risk Management 21. p.229-238
Abstract

Introduction: Acute lower limb ischemia (ALI) is a life and limb threatening event often affecting patients with type 2 diabetes mellitus (T2DM). Little is known about how T2DM affects the risk of adverse events in patients revascularized for ALI. This study aimed to investigate if there were differences in major outcomes between ALI patients with and without T2DM. Methods: Between 2010 and 2014, 615 patients underwent revascularization for ALI, according to the Swedish Vascular Registry (SWEDVASC). Using the National Diabetes Registry (NDR), 245 (39.8%) of the patients were identified as having T2DM. Uni-and multivariable Cox or logistic regression analyses were performed to evaluate risk differences for major amputation, mortality,... (More)

Introduction: Acute lower limb ischemia (ALI) is a life and limb threatening event often affecting patients with type 2 diabetes mellitus (T2DM). Little is known about how T2DM affects the risk of adverse events in patients revascularized for ALI. This study aimed to investigate if there were differences in major outcomes between ALI patients with and without T2DM. Methods: Between 2010 and 2014, 615 patients underwent revascularization for ALI, according to the Swedish Vascular Registry (SWEDVASC). Using the National Diabetes Registry (NDR), 245 (39.8%) of the patients were identified as having T2DM. Uni-and multivariable Cox or logistic regression analyses were performed to evaluate risk differences for major amputation, mortality, major adverse cardiovascular events (MACE), and fasciotomy between patients with and without T2DM. Results: The rates of major amputation and mortality at one year were 32.7% and 21.6% in the T2DM group, compared to 21.9% and 31.9% in the non-DM group, respectively, resulting in a hazard ratio (HR) of 1.52 (95% confidence interval [CI] 1.12–2.07) for major amputation and HR of 0.64 (95% CI 0.46–0.88) for mortality. At one year, the HR for major amputation was 1.45 (95% CI 0.99–2.11), HR for mortality 0.92 (95% CI 0.61–1.39), HR for combined major amputation/mortality 1.27 (95% CI 0.94–1.72), and HR for MACE 1.24 (95% CI 0.92–1.67) for those with T2DM compared to those without in the multivariable Cox-regression analyses. The multi-variable logistic regression analysis showed significantly lower odds of fasciotomy, OR 0.1 (95% CI 0.01–0.51) in the T2DM-group. Conclusion: T2DM was not significantly associated with higher hazard of major amputation, mortality, combined major amputation/ mortality, or MACE after revascularization for ALI, compared to patients without T2DM. Patients with T2DM had significantly lower odds of fasciotomy.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
acute lower limb ischemia, major amputation, type 2 diabetes mellitus
in
Vascular Health and Risk Management
volume
21
pages
10 pages
publisher
Dove Medical Press Ltd.
external identifiers
  • pmid:40236313
  • scopus:105003421977
ISSN
1176-6344
DOI
10.2147/VHRM.S497866
language
English
LU publication?
yes
id
bddd16fe-de60-429b-b91c-2ed6db7b14b7
date added to LUP
2025-09-24 13:37:49
date last changed
2025-10-08 10:02:29
@article{bddd16fe-de60-429b-b91c-2ed6db7b14b7,
  abstract     = {{<p>Introduction: Acute lower limb ischemia (ALI) is a life and limb threatening event often affecting patients with type 2 diabetes mellitus (T2DM). Little is known about how T2DM affects the risk of adverse events in patients revascularized for ALI. This study aimed to investigate if there were differences in major outcomes between ALI patients with and without T2DM. Methods: Between 2010 and 2014, 615 patients underwent revascularization for ALI, according to the Swedish Vascular Registry (SWEDVASC). Using the National Diabetes Registry (NDR), 245 (39.8%) of the patients were identified as having T2DM. Uni-and multivariable Cox or logistic regression analyses were performed to evaluate risk differences for major amputation, mortality, major adverse cardiovascular events (MACE), and fasciotomy between patients with and without T2DM. Results: The rates of major amputation and mortality at one year were 32.7% and 21.6% in the T2DM group, compared to 21.9% and 31.9% in the non-DM group, respectively, resulting in a hazard ratio (HR) of 1.52 (95% confidence interval [CI] 1.12–2.07) for major amputation and HR of 0.64 (95% CI 0.46–0.88) for mortality. At one year, the HR for major amputation was 1.45 (95% CI 0.99–2.11), HR for mortality 0.92 (95% CI 0.61–1.39), HR for combined major amputation/mortality 1.27 (95% CI 0.94–1.72), and HR for MACE 1.24 (95% CI 0.92–1.67) for those with T2DM compared to those without in the multivariable Cox-regression analyses. The multi-variable logistic regression analysis showed significantly lower odds of fasciotomy, OR 0.1 (95% CI 0.01–0.51) in the T2DM-group. Conclusion: T2DM was not significantly associated with higher hazard of major amputation, mortality, combined major amputation/ mortality, or MACE after revascularization for ALI, compared to patients without T2DM. Patients with T2DM had significantly lower odds of fasciotomy.</p>}},
  author       = {{Karonen, Emil and Eek, Frida and Drake, Isabel and Gottsäter, Anders and Acosta, Stefan and Butt, Talha and Carlsen, Hanne Krage and Eliasson, Björn}},
  issn         = {{1176-6344}},
  keywords     = {{acute lower limb ischemia; major amputation; type 2 diabetes mellitus}},
  language     = {{eng}},
  pages        = {{229--238}},
  publisher    = {{Dove Medical Press Ltd.}},
  series       = {{Vascular Health and Risk Management}},
  title        = {{Comparison of Outcomes After Revascularization for Acute Lower Limb Ischemia in Patients with and without Type 2 Diabetes Mellitus – A Nationwide Registry Study}},
  url          = {{http://dx.doi.org/10.2147/VHRM.S497866}},
  doi          = {{10.2147/VHRM.S497866}},
  volume       = {{21}},
  year         = {{2025}},
}