Interventional therapy for lower extremity vascular diseases in type 2 diabetic patients: long-term vascular restenosis and risk factors

Abstract

Objective To evaluate the rate of vascular restenosis following interventional therapy for lower extremity vascular disease and the factors contributing to its occurrence in type 2 diabetic patients. Methods We collected the data from 138 diabetic patients with lower extremity arterial disease (involving 154 limbs) undergoing interventional therapy in our department between January, 2008 and March, 2018. The patients received balloon dilatation and/or stent implantation according to the findings by digital angiography (DSA) of the lower extremity arteries. All the patients were followed up for more than 1 year to assess the surgical success rate, symptom improvement, ankle brachial index (ABI), toe brachial index (TBI), and restenosis rate. Glycosylated hemoglobin (HbA1c) level, liver function, renal function, blood lipids, and high-sensitivity C-reactive protein (hs-CRP) level were measured at 3 days and 1, 3, 6 and 12 months after the interventional therapy. Some of the patients underwent computed tomographic angiography (CTA) or ultrasound examination for assessment of the lower extremity blood vessels. Results The abnormalities in HDL-C, LDL-C, hs-CRP, and HbA1c levels were significantly improved in these patients after interventional therapy (P < 0.05). At 1, 3, 6, and 12 months after the operation, the ABI and TBI showed significant improvements (P < 0.05 or 0.01) and the restenosis rates were 17.6%, 17.8%, 20%, and 20.9% in these patients, respectively. In patients with diseased vessels above the knee, the restenosis rate was 8.3%, 7.7%, 5.6%, and 23.1% at 1, 3, 6 and 12 months after the operation, respectively, as compared with 37.5%, 30%, 37.5%, and 30.8% in patients with diseased vessels below the knee and with 7.9%, 15%, 14.0%, 10.7% in those with diseased vessels both below and above the knee. Multivariate logistic regression analysis suggested that preoperative total cholesterol (TC) level was a risk factor that affected the outcome of interventional therapy (R=0.356, P=0.026), and preoperative HbA1c was a risk factor for the occurrence of restenosis (R=1.348, P=0.040). In patients with diseased vessels below the knee, TC and LDL-C levels were decreased more obviously in patients without than in those with vascular restenosis. Conclusion Interventional therapy can significantly improve lower limb perfusion in type 2 diabetic patients with lower extremity arterial disease. The incidence of postoperative vascular restenosis is associated with the site of operation, and is higher in patients having operations below the knee than those with operations above the knee or both below and above the knee. Controlling blood glucose, blood lipids and other metabolic indicators can help to improve the efficacy of interventional therapy and reduce the occurrence of postoperative vascular restenosis.

Keywords

• type 2 diabetes mellitus
• lower extremity arterial disease
• interventional therapy