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For diabetic patients with critical limb ischemia, the risk of major amputation and death is “considerable,” researchers report. Study investigator Dr. Giacomo Clerici stated that, “Reduction in the amputation rate among diabetic patients with ischemic diabetic foot is possible” with the extensive use of revascularization by means of both bypass graft and peripheral angioplasty.
| “With the use of both,” Dr. Clerici added, “the revascularization rate is about 95% — at the beginning of the ’90s we were only able to revascularize about 25% of diabetic patients with critical limb ischemia.”
To gain information on more recent outcomes, Dr. Clerici, of the Diabetic Foot Center, IRCCS Multimedica, Milan, and colleagues examined data on 564 patients who had been hospitalized at the center between 1999 and 2003. They were followed for a mean of almost 6 years. Peripheral angioplasty was performed in 420 patients (74.5%) and bypass graft in 117 (20.6%). Revascularization was not possible in 27 patients (4.9%). According to the investigators, major amputations were performed in a total of 74 patients (13.4%). This was true of 8.2% of peripheral angioplasty patients, 21.1% of bypass graft patients, and 59.2% of patients who did not undergo revascularization. “The rate of amputation was consistently lower in patients that received revascularization compared with patients that could not undergo revascularization,” the investigators point out. Critical limb ischemia was seen in the contralateral limb of 225 patients (39.9%) and 6.7% required major amputations involving that limb, the investigators report. During follow-up, 276 patients died (49.8%). Cardiac diseases accounted for 64.9% of the deaths. The hazard ratios for death were 3.06 in patients with no possibility of revascularization, 3.0 in patients on dialysis, and 1.37 in patients with a history of cardiac disease. “Overall, a multidisciplinary approach is the key to success,” Dr. Clerici said. “Revascularization and correct foot care improve the prognosis of these patients and reduce the need of other interventions.” “Coronary artery disease,” the researcher added, “is the leading cause of death. For this reason it is important to pay attention to the heart and find out about silent ischemia to try to improve survival.” Diabetes Care May, 2009;32:822-827. |