Long-term prognosis of diabetic patients with critical limb ischemia : a population-based cohort study
Articolo
Data di Pubblicazione:
2009
Citazione:
Long-term prognosis of diabetic patients with critical limb ischemia : a population-based cohort study / E. Faglia, G. Clerici , J. Clerissi, L. Gabrielli, S. Losa, M. Mantero, M. Caminiti, V. Curci, A. Quarantiello, T. Lupattelli, A. Morabito. - In: DIABETES CARE. - ISSN 0149-5992. - 32:5(2009), pp. 822-827. [10.2337/dc08-1223]
Abstract:
OBJECTIVE— To evaluate the long-term prognosis of critical limb ischemia (CLI) in diabetic
patients.
RESEARCH DESIGN AND METHODS— A total of 564 consecutive diabetic patients
were hospitalized for CLI from January 1999 to December 2003; 554 were followed until
December 2007.
RESULTS— The mean follow-up was 5.93 1.28 years. Peripheral angioplasty (PTA) was
performed in 420 (74.5%) and bypass graft (BPG) in 117 (20.6%) patients. Neither PTA nor BPG
were possible in 27 (4.9%) patients. Major amputations were performed in 74 (13.4%) patients:
34 (8.2%) in PTA, 24 (21.1%) in BPG, and 16 (59.2%) in a group that received no revascularization.
Restenosis occurred in 94 patients, bypass failures in 36 patients, and recurrent ulcers in
71 patients. CLI was observed in the contralateral limb of 225 (39.9%) patients; of these, 15
(6.7%) required major amputations (rate in contralateral compared with initial limb, P 0.007).
At total of 276 (49.82%) patients died. The Cox model showed significant hazard ratios (HRs) for
mortality with age (1.05 for 1 year [95% CI 1.03–1.07]), unfeasible revascularization (3.06
[1.40–6.70]), dialysis (3.00 [1.63–5.53]), cardiac disease history (1.37 [1.05–1.79]), and impaired
ejection fraction (1.08 for 1% point [1.05–1.09]).
CONCLUSIONS— Diabetic patients with CLI have high risks of amputation and death. In
a dedicated diabetic foot center, the major amputation, ulcer recurrence, and major contralateral
limb amputation rates were low. Coronary artery disease (CAD) is the leading cause of death, and
in patients with CAD history the impaired ejection fraction is the major independent prognostic
factor.
Tipologia IRIS:
01 - Articolo su periodico
Elenco autori:
E. Faglia, G. Clerici, J. Clerissi, L. Gabrielli, S. Losa, M. Mantero, M. Caminiti, V. Curci, A. Quarantiello, T. Lupattelli, A. Morabito
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