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Diabetes Does Not Worsen Outcomes following Open Lower Extremity Bypass or Endovascular Intervention for Patients with Critical Limb Ischemia
Caitlin W. Hicks, MD, MS, Alireza Najafian, MD, Mahmoud B. Malas, MD, MHS, James H. Black, III, MD, Christopher J. Abularrage, MD.
Johns Hopkins Hospital, Baltimore, MD, USA.
OBJECTIVES:
Both open surgery and endovascular peripheral interventions have been shown to effectively improve outcomes in patients with peripheral arterial disease, but minimal data exist comparing outcomes performed at and below the knee and within patients with diabetes specifically. The purpose of this study is to compare outcomes following open bypass vs. peripheral vascular intervention (PVI) at and below the knee in diabetic (DM) vs. non-DM patients with critical limb ischemia.
METHODS:
Data from the 2008-2014 Vascular Quality Initiative were analyzed. All patients undergoing open bypass or PVI at or below the knee for rest pain or tissue loss were included. Amputation, primary patency, and death rates were compared following open bypass vs. PVI and for patients with DM vs. no-DM.
RESULTS:
Overall, 2566 patients were included (open bypass=500, PVI=2066). Patients undergoing open bypass were more frequently male (72.6% vs. 65.0%, p=0.001) and of black race (19.2% vs. 15.9%, p=0.01) compared to patients undergoing PVI. Median age (67 yrs vs. 70 yrs) and DM prevalence (71.0% vs. 70.8%) were similar between groups (p=NS). There were no differences for open bypass vs. PVI in terms of frequency of amputation (14.6% vs. 12.3%; p=0.27), primary patency (65.6% vs. 68.2%; p=0.27) or death (9.2 vs. 10.0%; p=0.40). Within patients with DM specifically, outcomes following open bypass vs. PVI were also similar (amputation: 15.8% vs. 11.2%; primary patency: 65.1% vs. 68.2%; death: 10.1% vs. 6.2%; all, p≥0.16). Comparing patients with DM vs. no DM, there were no differences in any outcome following either open bypass (amputation: 15.8% vs. 11.7%; primary patency: 65.1% vs. 66.9%; death: 10.1% vs. 6.2%; all, p≥0.16) or PVI (amputation: 13.5% vs. 11.0%; primary patency: 68.2% vs. 68.2%; death: 9.5% vs. 12.1%; all, p≥0.09).
CONCLUSIONS:
Outcomes following attempts at limb salvage among patients with critical limb ischemia are similar for open surgery and PVI in both diabetics and non-diabetics. In cases of rest pain and tissue loss, the decision to use open versus endovascular interventions to restore lower extremity blood flow should be made based on clinical factors irrespective of diabetes status.
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