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Insulin-Dependent Status Influences Post-Procedural Outcomes in Diabetic Patients Following Lower Extremity Endovascular Intervention for Peripheral Arterial Disease

  • Clinical Investigation
  • Arterial Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

Diabetic patients are at increased risk of developing lower extremity peripheral arterial disease (PAD) requiring revascularization. This study assessed the effect of insulin dependence in diabetics on post-procedural outcomes following infra-inguinal endovascular intervention.

Materials and Methods

The American College of Surgeon’s National Surgical Quality Improvement Program database was used to identify 8022 patients undergoing infra-inguinal endovascular interventions between 2014 and 2017. Thirty-day post-procedural outcomes for patients without diabetes, with non-insulin-dependent diabetes mellitus (NIDDM), and with insulin-dependent diabetes mellitus (IDDM) were compared.

Results

At presentation, IDDM patients were more likely to present with critical limb ischemia compared to NIDDM and non-diabetic patients. In propensity score-weighted logistic regression analysis, IDDM status was an independent predictor for increased renal complication (odds ratio [OR] = 3.08, confidence interval [CI] = 1.44–6.65), sepsis (OR = 1.68, CI = 1.13–2.48), wound complication (OR = 1.57, CI = 1.09–2.25, p = 0.006), UTI (OR = 2.07, CI = 1.09–3.94, p = 0.03), and readmission (OR = 1.21, CI = 1.03–1.42). NIDDM status was an independent predictor for increased risk of renal complications (OR = 2.80, CI = 1.18–6.63).

Conclusions

IDDM status is an independent predictor for increased risk of 30-day post-procedural complications and readmission compared to both NIDDM and non-diabetic status in patients undergoing lower extremity endovascular interventions for PAD.

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References

  1. Centers for Disease Control and Prevention. Diabetes Report Card 2019. GA: Atlanta; 2019.

    Google Scholar 

  2. Criqui MH, Aboyans V. Epidemiology of peripheral artery disease. Circ Res. 2015;116:1509–26.

    Article  CAS  Google Scholar 

  3. Barshes NR, Grant CL. Advances in the management of peripheral artery disease. Curr Diab Rep. 2019;19:1–7.

    Article  Google Scholar 

  4. Bradbury AW, Adam DJ, Beard JD, Cleveland T, Forbes JF, Fowkes FGR, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005;366:1925–34.

    Article  Google Scholar 

  5. Bradbury AW, Adam DJ, Bell J, Forbes JF, Fowkes FGR, Gillespie I, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL) trial an intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy. J Vasc Surg. 2010;51(5):5–17.

    Article  Google Scholar 

  6. Hingorani A, Lamuraglia GM, Henke P, Meissner MH, Loretz L, Zinszer KM, et al. The management of diabetic foot: a clinical practice guideline by the Society for vascular surgery in collaboration with the American podiatric medical association and the society for vascular medicine. J Vasc Surg. 2016;63:3S-21S.

    Article  Google Scholar 

  7. Jude E, Oyibo S, Chalmers N. Boulton A, peripheral arterial disease in diabetic and nondiabetic patients. Diabetes Care. 2001;24(8):1433–7.

    Article  CAS  Google Scholar 

  8. Dick F, Diehm N, Galimanis A, Husmann M, Schmidli J, Baumgartner I. Surgical or endovascular revascularization in patients with critical limb ischemia: influence of diabetes mellitus on clinical outcome. J Vasc Surg. 2007;45:751–61.

    Article  Google Scholar 

  9. Abularrage CJ, Conrad MF, Hackney LA, Paruchuri V, Crawford RS, Kwolek CJ, et al. Long-term outcomes of diabetic patients undergoing endovascular infrainguinal interventions. J Vasc Surg. 2010;52(2):314–22.

    Article  Google Scholar 

  10. Shammas AN, Jeon-Slaughter H, Tsai S, Khalili H, Ali M, Xu H, et al. Major limb outcomes following lower extremity endovascular revascularization in patients with and without diabetes mellitus. J Endovasc Ther. 2017;24:376–82.

    Article  Google Scholar 

  11. Thiruvoipati T. Peripheral artery disease in patients with diabetes: epidemiology, mechanisms, and outcomes. World J Diabetes. 2015;6:961.

    Article  Google Scholar 

  12. American College of Surgeons National Surgical Quality Improvement Program. Participants. Chicago, IL, USA; 2016.

  13. American College of Surgeons National Surgical Quality Improvement Program. ACS-NSQIP user guide for the 2017 participant data use file. Chicago, IL, USA; 2017.

  14. Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, et al. AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: a report of the American college of cardiology/American heart association task force on clinical practice guidelines. Circ. 2017;69(11):1465–508.

    Google Scholar 

  15. Arya S, Binney ZO, Khakharia A, Long CA, Brewster LP, Wilson PW, et al. High hemoglobin A 1c associated with increased adverse limb events in peripheral arterial disease patients undergoing revascularization. J Vasc Surg. 2018;67(1):217–28.

    Article  Google Scholar 

  16. Hjellestad ID, Søfteland E, Husebye ES, Jonung T. HbA1c predicts long-term postoperative mortality in patients with unknown glycemic status at admission for vascular surgery: an exploratory study. J Diabetes. 2019;11:466–76.

    Article  CAS  Google Scholar 

  17. Vogel TR, Smith JB, Kruse RL. The association of postoperative glycemic control and lower extremity procedure outcomes . J Vasc Surg. 2017;66(4):1123–32.

    Article  Google Scholar 

  18. Hirashima F, Patel RB, Adams JE, Bertges DJ, Callas PW, Steinthorsson G, et al. Use of a postoperative insulin protocol decreases wound infection in diabetics undergoing lower extremity bypass. J Vasc Surg. 2012;56(2):396–402.

    Article  Google Scholar 

  19. Lazaris AM, Tsiamis AC, Fishwick G, Bolia A, Bell PRF. Clinical outcome of primary infrainguinal subintimal angioplasty in diabetic patients with critical lower limb ischemia. J Endovasc Ther. 2004;11:447–53.

    Article  Google Scholar 

  20. Hicks CW, Najafian A, Farber A, Menard MT, Malas MB, Black JH, et al. Diabetes does not worsen outcomes following infrageniculate bypass or endovascular intervention for patients with critical limb ischemia. J Vasc Surg. 2016;64(6):1667–74.

    Article  Google Scholar 

  21. Goldman MP, Clark CJ, Craven TE, Davis RP, Williams TK, Velazquez-Ramirez G, et al. Effect of intensive glycemic control on risk of lower extremity amputation. J Am Coll Surg. 2018;227(6):596–604.

    Article  Google Scholar 

  22. Van Den Berghe G, Wouters PJ, Bouillon R, Weekers F, Verwaest C, Schetz M, et al. Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Crit Care Med. 2003;31:359–66.

    Article  Google Scholar 

  23. Van Den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345:1359–67.

    Article  Google Scholar 

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Authors and Affiliations

  1. MGH Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Thomas J. An, Rory L. Cochran, John Di Capua & T. Gregory Walker

  2. Harvard Medical School, Boston, USA

    Thomas J. An, Rory L. Cochran, John Di Capua, Nicholas Reid & T. Gregory Walker

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  1. Thomas J. An
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  2. Rory L. Cochran
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Correspondence to T. Gregory Walker.

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An, T.J., Cochran, R.L., Di Capua, J. et al. Insulin-Dependent Status Influences Post-Procedural Outcomes in Diabetic Patients Following Lower Extremity Endovascular Intervention for Peripheral Arterial Disease. Cardiovasc Intervent Radiol 44, 1165–1173 (2021). https://doi.org/10.1007/s00270-021-02830-4

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  • DOI: https://doi.org/10.1007/s00270-021-02830-4

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