Diabetic peripheral arterial disease: lower limb angiography results and one year outcomes of interventional treatment / 中华放射学杂志

ABSTRACT

Objective To demonstrate lower limb angiography results of peripheral arterial disease (PAD) in diabetics and evaluate one-year curative effect after interventional therapy. Methods Lower limb angiography results and the efficiency of interventional therapy for 44 limbs with PAD in 38 diabetics were retrospectively analyzed. Post-treatment clinical manifestations, signs and ankle-brachial-index (ABI) at 1 week, 1 month, 3 months, 6 months and 12 months were compared with those before treatment. Clinical evaluation was divided into four grades apparent, effective, ineffective and deterioration. Efficiency =(apparent + effective ) / total cases ÷ 100%. ABI was compared using analysis of variance. Results Lower limb angiography revealed multi-branch lesions, with multi-segmental stenoses or obstructions.Lesions involved both above- and below-the-knee arteries in 25 limbs (56. 8% ), only above-the-knee arteries in 3 limbs (6. 8% ) and only below-the-knee arteries in 16 limbs (36. 4% ). In the limbs only with below-the-knee arterial lesions, the involved artery branches were one in one limb (2. 3% ), two in six limbs ( 13. 6% ) and three in nine limbs ( 20. 5% ), respectively. The technical success rate of percutaneous transluminal angioplasty (PTA) was 91.4% ( 53/58 ) for diseased below-the-knee arteries. Among the 12 cases with foot and ankle ulcers, ulcers healed within 3 months in 9 cases; however, the other three cases suffered below-the-ankle (in one case) or below-the-knee amputation (in two cases) within 6 months. Four cases with gangrene suffered below-the-knee amputation within one month after PTA. The amputation rate was 15. 9% (7/44). At 1 week, 1, 3, 6 and 12 months after PTA, the effective rates were 79. 6%(35/44), 83.3% (30/36), 85.7% (24/28), 85.0% (17/20) and 81.3% ( 13/16), respectively; ABI values were 0. 86 ± 0. 10, 0. 85 ± 0. 10, 0. 83 ± 0. 11, 0. 79 ± 0. 12 and 0. 75 ± 0. 12, respectively.Compared with pre-PTA ABI value (0. 53 ±0. 20), post-PTA ABI value was significant higher (F=35.79,P ＜ 0. 05 ). However, ABI value began to decline from the 6th month after PTA. Conclusions In diabetics, PAD always involves both above- and below-the-knee arteries. PTA is a feasible and effective revascularization therapy, which could improve the clinical signs and symptoms of lower limb ischemia in diabetics with PAD. The clinical effect is satisfactory during short-term follow-up.