Diabetic versus nondiabetic limb-threatening ischemia: Outcome of percutaneous iliac intervention

OBJECTIVE. The purpose of this study was to compare the effectiveness of il iac angioplasty and outcomes in diabetic patients and nondiabetic patients with limb-threatening ischemia. MATERIALS AND METHODS. Records of 91 consecutive patients with limb-threate ning ischemia (rest pain, nonhealing ulceration, or gangrene) who, during a 6-year period, underwent iliac angioplasty of hemodynamically significant lesions were reviewed. Stents were placed in patients with suboptimal findi ngs at angioplasty. Sixty-eight (75%) of the 91 patients were diabetic. Lif e table analysis and log-rank significance tests were used to compare rates of primary iliac artery patency, primary and secondary graft patency, limb salvage, and survival in diabetic patients versus nondiabetic patients. RESULTS. One hundred seven iliac lesions were treated with percutaneous ang ioplasty. Ten iliac stents were placed because of suboptimal results at ang ioplasty. The mean time of follow-up was 20 months (range, 2-62 months). Si xty-eight patients (75%) underwent peripheral reconstruction. Outcomes were comparable in both patient groups for primary iliac patencies at 4 years ( diabetic patients, 85%; nondiabetic patients, 76%; p =.5), primary and seco ndary graft patencies at 4 years (diabetic patients, 65% and 73%, respectiv ely; nondiabetic patients, 74% and 100%, respectively; p =.7 and .19, respe ctively), 4-year limb-salvage rates (diabetic patients, 93%; nondiabetic pa tients, 79%;p =.07). Major complications of angioplasty occurred in four pa tients (4.4%). CONCLUSION. Outcomes of iliac angioplasty and limb-salvage rates were compa rable for diabetic patients and nondiabetic patients who underwent current methods of iliac angioplasty and infrainguinal reconstruction.