Outcomes after first-time lower extremity revascularization for chronic limb-threatening ischemia between patients with and without diabetes

Jeremy D. Darling, Thomas C. F. Bodewes, Sarah E. Deery, Raul J. Guzman, Mark C. Wyers, Allen D. Hamdan, Hence J. Verhagen, Marc L. Schermerhorn

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

RESULTS: Of 2869 infrainguinal revascularizations from 2005 to 2014, 1294 limbs (646 BPG, 648 PTA/S) fit our criteria. Overall, our analysis included 703 IDDM, 262 NIDDM, and 329 NDM limbs. IDDM patients, compared with NIDDM and NDM patients, were younger (69 vs 73 vs 77 years; P < .001) and more often presented with tissue loss (89% vs 77% vs 67%; P < .001), coronary artery disease (57% vs 48% vs 43%; P < .001), and end-stage renal disease (26% vs 13% vs 12%; P < .001). Perioperative complications, including mortality (3% vs 2% vs 5%; P = .07), did not differ between groups; however, complete wound healing at 6-month follow-up was significantly worse among IDDM patients (41% vs 49% vs 61%; P < .001). IDDM patients had significantly higher 3-year major amputation rates (23% vs 11% vs 8%; P < .001). Multivariable analyses illustrated that compared with NDM, IDDM was associated with significantly higher risk of both major amputation and RAS events after any first-time intervention (hazard ratio, 2.0 [95% confidence interval, 1.1-4.1] and 1.4 [1.1-1.8], respectively). Similar associations between IDDM and both major amputation and RAS events were found in patients undergoing a PTA/S-first intervention (4.1 [1.3-12.6] and 1.5 [1.1-2.2], respectively), whereas IDDM in BPG-first patients was associated with only incomplete wound healing (2.0 [1.4-4.5]). Last, compared with NDM, NIDDM was associated with lower late mortality (0.7 [0.5-0.9]).
Original languageEnglish
Pages (from-to)1159-1169
JournalJournal of Vascular Surgery
Volume67
Issue number4
DOIs
Publication statusPublished - 2018
Externally publishedYes

Cite this

Darling, J. D., Bodewes, T. C. F., Deery, S. E., Guzman, R. J., Wyers, M. C., Hamdan, A. D., ... Schermerhorn, M. L. (2018). Outcomes after first-time lower extremity revascularization for chronic limb-threatening ischemia between patients with and without diabetes. Journal of Vascular Surgery, 67(4), 1159-1169. https://doi.org/10.1016/j.jvs.2017.06.119
Darling, Jeremy D. ; Bodewes, Thomas C. F. ; Deery, Sarah E. ; Guzman, Raul J. ; Wyers, Mark C. ; Hamdan, Allen D. ; Verhagen, Hence J. ; Schermerhorn, Marc L. / Outcomes after first-time lower extremity revascularization for chronic limb-threatening ischemia between patients with and without diabetes. In: Journal of Vascular Surgery. 2018 ; Vol. 67, No. 4. pp. 1159-1169.
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title = "Outcomes after first-time lower extremity revascularization for chronic limb-threatening ischemia between patients with and without diabetes",
abstract = "RESULTS: Of 2869 infrainguinal revascularizations from 2005 to 2014, 1294 limbs (646 BPG, 648 PTA/S) fit our criteria. Overall, our analysis included 703 IDDM, 262 NIDDM, and 329 NDM limbs. IDDM patients, compared with NIDDM and NDM patients, were younger (69 vs 73 vs 77 years; P < .001) and more often presented with tissue loss (89{\%} vs 77{\%} vs 67{\%}; P < .001), coronary artery disease (57{\%} vs 48{\%} vs 43{\%}; P < .001), and end-stage renal disease (26{\%} vs 13{\%} vs 12{\%}; P < .001). Perioperative complications, including mortality (3{\%} vs 2{\%} vs 5{\%}; P = .07), did not differ between groups; however, complete wound healing at 6-month follow-up was significantly worse among IDDM patients (41{\%} vs 49{\%} vs 61{\%}; P < .001). IDDM patients had significantly higher 3-year major amputation rates (23{\%} vs 11{\%} vs 8{\%}; P < .001). Multivariable analyses illustrated that compared with NDM, IDDM was associated with significantly higher risk of both major amputation and RAS events after any first-time intervention (hazard ratio, 2.0 [95{\%} confidence interval, 1.1-4.1] and 1.4 [1.1-1.8], respectively). Similar associations between IDDM and both major amputation and RAS events were found in patients undergoing a PTA/S-first intervention (4.1 [1.3-12.6] and 1.5 [1.1-2.2], respectively), whereas IDDM in BPG-first patients was associated with only incomplete wound healing (2.0 [1.4-4.5]). Last, compared with NDM, NIDDM was associated with lower late mortality (0.7 [0.5-0.9]).",
author = "Darling, {Jeremy D.} and Bodewes, {Thomas C. F.} and Deery, {Sarah E.} and Guzman, {Raul J.} and Wyers, {Mark C.} and Hamdan, {Allen D.} and Verhagen, {Hence J.} and Schermerhorn, {Marc L.}",
year = "2018",
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Darling, JD, Bodewes, TCF, Deery, SE, Guzman, RJ, Wyers, MC, Hamdan, AD, Verhagen, HJ & Schermerhorn, ML 2018, 'Outcomes after first-time lower extremity revascularization for chronic limb-threatening ischemia between patients with and without diabetes' Journal of Vascular Surgery, vol. 67, no. 4, pp. 1159-1169. https://doi.org/10.1016/j.jvs.2017.06.119

Outcomes after first-time lower extremity revascularization for chronic limb-threatening ischemia between patients with and without diabetes. / Darling, Jeremy D.; Bodewes, Thomas C. F.; Deery, Sarah E.; Guzman, Raul J.; Wyers, Mark C.; Hamdan, Allen D.; Verhagen, Hence J.; Schermerhorn, Marc L.

In: Journal of Vascular Surgery, Vol. 67, No. 4, 2018, p. 1159-1169.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Outcomes after first-time lower extremity revascularization for chronic limb-threatening ischemia between patients with and without diabetes

AU - Darling, Jeremy D.

AU - Bodewes, Thomas C. F.

AU - Deery, Sarah E.

AU - Guzman, Raul J.

AU - Wyers, Mark C.

AU - Hamdan, Allen D.

AU - Verhagen, Hence J.

AU - Schermerhorn, Marc L.

PY - 2018

Y1 - 2018

N2 - RESULTS: Of 2869 infrainguinal revascularizations from 2005 to 2014, 1294 limbs (646 BPG, 648 PTA/S) fit our criteria. Overall, our analysis included 703 IDDM, 262 NIDDM, and 329 NDM limbs. IDDM patients, compared with NIDDM and NDM patients, were younger (69 vs 73 vs 77 years; P < .001) and more often presented with tissue loss (89% vs 77% vs 67%; P < .001), coronary artery disease (57% vs 48% vs 43%; P < .001), and end-stage renal disease (26% vs 13% vs 12%; P < .001). Perioperative complications, including mortality (3% vs 2% vs 5%; P = .07), did not differ between groups; however, complete wound healing at 6-month follow-up was significantly worse among IDDM patients (41% vs 49% vs 61%; P < .001). IDDM patients had significantly higher 3-year major amputation rates (23% vs 11% vs 8%; P < .001). Multivariable analyses illustrated that compared with NDM, IDDM was associated with significantly higher risk of both major amputation and RAS events after any first-time intervention (hazard ratio, 2.0 [95% confidence interval, 1.1-4.1] and 1.4 [1.1-1.8], respectively). Similar associations between IDDM and both major amputation and RAS events were found in patients undergoing a PTA/S-first intervention (4.1 [1.3-12.6] and 1.5 [1.1-2.2], respectively), whereas IDDM in BPG-first patients was associated with only incomplete wound healing (2.0 [1.4-4.5]). Last, compared with NDM, NIDDM was associated with lower late mortality (0.7 [0.5-0.9]).

AB - RESULTS: Of 2869 infrainguinal revascularizations from 2005 to 2014, 1294 limbs (646 BPG, 648 PTA/S) fit our criteria. Overall, our analysis included 703 IDDM, 262 NIDDM, and 329 NDM limbs. IDDM patients, compared with NIDDM and NDM patients, were younger (69 vs 73 vs 77 years; P < .001) and more often presented with tissue loss (89% vs 77% vs 67%; P < .001), coronary artery disease (57% vs 48% vs 43%; P < .001), and end-stage renal disease (26% vs 13% vs 12%; P < .001). Perioperative complications, including mortality (3% vs 2% vs 5%; P = .07), did not differ between groups; however, complete wound healing at 6-month follow-up was significantly worse among IDDM patients (41% vs 49% vs 61%; P < .001). IDDM patients had significantly higher 3-year major amputation rates (23% vs 11% vs 8%; P < .001). Multivariable analyses illustrated that compared with NDM, IDDM was associated with significantly higher risk of both major amputation and RAS events after any first-time intervention (hazard ratio, 2.0 [95% confidence interval, 1.1-4.1] and 1.4 [1.1-1.8], respectively). Similar associations between IDDM and both major amputation and RAS events were found in patients undergoing a PTA/S-first intervention (4.1 [1.3-12.6] and 1.5 [1.1-2.2], respectively), whereas IDDM in BPG-first patients was associated with only incomplete wound healing (2.0 [1.4-4.5]). Last, compared with NDM, NIDDM was associated with lower late mortality (0.7 [0.5-0.9]).

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U2 - 10.1016/j.jvs.2017.06.119

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