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Comparison of Clinical outcomes of Infragenicular Angioplasty between diabetic and non-diabetic patients with Peripheral Arterial Occlusive Disease

Walid M Gamal, Zeinab Mohammed Askary and Mohamed Ibrahim

Background: Infragenicular angioplasty could salvage most of limbs under amputation impendence. We aim in our study to detect the results of infragenicular angioplasty in diabetic and non-diabetic patients with critical lower limb ischemia (CLI).

Patients and methods: Between April 2014 and May 2017,infragenicular angioplasty was carried out on 139 patients out of 154 patients (as 15 patients missed the follow up program or their data were lost) with CLI (Rutherford category 4,5 or 6) whom attended to The Vascular surgery Department of Qena University and Assiut University Hospitals. After obtaining informed written consent from all subjects, they were divided into diabetic group (n=62) and non-diabetic group (n=77).For all subjects pre-procedure, ankle brachial indexes (ABI) and computed tomography angiography (CTA) had been done. The percutaneous transluminal angioplasty (PTA) procedure was done alone or combined with stenting. The investigated outcomes comprised rest ABI, primary, secondary patency rates and finally limb-salvage rates 6, 12, 24 and 36 months after treatment.

Results: There were no significant differences between both groups in technical success rate (98.4 vs. 100%, P=0.133).Primary , secondary patency rates and limb salvage rates 6,12,24 and 36 months in both diabetic and non-diabetic groups were not significantly different (p value>0.001) The mean value of ankle brachial indexes was significantly increased after intervention (0.397 ± 0.125 versus 0.779 ± 0.137, t=-25.780, P<0.001) in diabetic group and (0.406 ± 0.101 versus 0.786 ± 0.121, t=-37.221, P<0.001) in non-diabetic group. Perioperative 30 day mortality was 0%. Major complications were groin hematoma in 7.3%, and formation of pseudo- aneurysms in 2.1% of subjects.

Conclusion: Infragenicular percutaneous angioplasty is a valuable option in CLI management with low risk of both morbidity and mortality. The efficiency and outcomes of interventional procedures in diabetic patients is similar to that in non-diabetics.