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Titolo:
Comparison of peripheral arterial reconstruction in diabetic and non-diabetic patients: a prospective clinic-based study
Autore:
Calle-Pascual, AL; Duran, A; Diaz, A; Monux, G; Serrano, FJ; de la Torre, NG; Moraga, I; Calle, JR; Charro, A; Maranes, JP;
Indirizzi:
1aS Hosp Clin San Carlos, Serv Endocrinol & Nutr, E-28040 Madrid, Spain 1aS Hosp Clin San Carlos Madrid Spain E-28040 utr, E-28040 Madrid, Spain Hosp Clin San Carlos, Serv Cirurg Vasc, Madrid, Spain Hosp Clin San Carlos Madrid Spain rlos, Serv Cirurg Vasc, Madrid, Spain
Titolo Testata:
DIABETES RESEARCH AND CLINICAL PRACTICE
fascicolo: 2, volume: 53, anno: 2001,
pagine: 129 - 136
SICI:
0168-8227(200108)53:2<129:COPARI>2.0.ZU;2-4
Fonte:
ISI
Lingua:
ENG
Soggetto:
LIMB SALVAGE; CORONARY ANGIOPLASTY; VASCULAR-SURGERY; FOOT CARE; DISEASE; AMPUTATION; MELLITUS; BYPASS; REVASCULARIZATION; PREVALENCE;
Keywords:
arterial reconstruction; diabetes mellitus; diabetic foot; limb salvage; neuropathy; mortality;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
36
Recensione:
Indirizzi per estratti:
Indirizzo: Calle-Pascual, AL 1aS Hosp Clin San Carlos, Serv Endocrinol & Nutr, MartinLagos S-N, E-28040 Madrid, Spain 1aS Hosp Clin San Carlos Martin Lagos S-NMadrid Spain E-28040
Citazione:
A.L. Calle-Pascual et al., "Comparison of peripheral arterial reconstruction in diabetic and non-diabetic patients: a prospective clinic-based study", DIABET RE C, 53(2), 2001, pp. 129-136

Abstract

To assess the efficacy and safety of lower extremity arterial reconstruction in diabetic and non-diabetic subjects during a 3-year period. A prospective clinic-based study between 1994-1999 in Area 7, Madrid, with a population of 569307 and an estimated diabetic population of 37932 (15505 men and 22427 women). The level of arterial reconstruction and associated risk factors were ascertained. Results: A total of 588 peripheral revascularization surgical procedures were performed in 481 patients. The diabetic patients (n= 174, 36.2%) underwent 222 surgical procedures (including 48 follow-on operations. 21.6%), and 307 non-diabetic subjects underwent 366 surgical procedures (59 follow-on operations, 16. 1%). The numbers of surgical procedures per 100000 people at risk and year were 18.8 and 1.8 for non-diabetic menand women, respectively, and 145.1 and 29.0 for men and women with diabetes mellitus (7.7- and 16.2-fold, respectively). Age at reconstruction surgery was 2 and 5 years earlier in non-diabetic than in diabetic men and women,respectively. Diabetic patients had a higher neuropathy score (P < 0.05) and were less frequently smokers (P < 0.05) than non-diabetic subjects. Diabetic subjects more frequently had distal reconstruction while proximal arterial reconstruction was more often performed in non-diabetic subjects. Between 64.6 and 80.4% of people with diabetes and 82.3 and 88.9% of non-diabetic subjects had no complications during their in-hospital stay. Distal amputation simultaneous to arterial reconstruction was the most frequent morbidity of people with diabetes during the study (P < 0.05). Despite a graft occlusion rate after femoropopliteal revascularization significantly higher than in non-diabetic people (P < 0.05), diabetic people more often required lower extremity amputations (LEAs) for the same level of bypass (P < 0.01). Cumulative limb salvage rates were lower in diabetic patients than in non-diabetic subjects at femoropopliteal (49.2 vs. 89.7% P < 0.001), femorodistal (73.5 vs. 95.2%; P < 0.01), and distal reverse (77.9 vs. 87.3%; P < 0.05) arterial reconstruction, at the end of the third year, but similar after aorto-iliac reconstruction (93.1 vs. 97.5%). A higher neuropathy score and the presence of foot ulcers were associated to significantly lower limb salvage in diabetic patients (P < 0.05), but not in non-diabetic people. Survival rates after 3 years were similar between diabetic and non-diabetic populations after aorto-iliac (93.1 vs. 97.5%) Femoropopliteal (97.2 vs. 90.3%), and distal reverse (93.1 vs. 98.1%) revascularization, and slightly lowerin diabetic compared to non-diabetic patients after. femorodistal revascularization (87.1 vs. 96.3%; P<0.05). Conclusion: Although limb salvage afterarterial reconstruction is loud in diabetic than ill non-diabetic subjects, particularly in those with a higher neuropathy score, this surgical approach can be applied in both diabetic and non-diabetic subjects with otherwise similar outcome. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 05/04/20 alle ore 07:02:35