Percutaneous transluminal angioplasty in diabetic and non diabetic peripheral artery disease: Results of a 5-year follow-up study [Angioplastica degli arti inferiori in diabetici e non diabetici con arteriopatia obliterante degli arti inferiori: dati di follow-upa 5 anni]

The aim of our study was to determine the prevalence of risk factors, comorbidity and clinical long-term (5 years) outcomes in a selected population of diabetic and non diabetic patients with symptomatic PAD (stage IIb-IV) candidate to endovascular revascularization with percutaneous angioplasty (PTA). We report data related to 103 patients (57 M, 46 F, aged 70.1 ± 7.2), with symptomatic PAD confirmed by clinical and diagnostic tests who underwent endovascular revascularization with PTA (2001-2003). All patients underwent clinical evaluation, determination of biohumoral cardiovascular risk factors and preliminary diagnostic tests (ultrasonography, angio-CT, angio-NMR) before undergoing endovascular procedures. All patients were evaluated with ultrasonography and clinical follow-up 1, 3 and 5 years after PTA, respectively. On preliminary evaluation, the main risk factors were hypertension (82,5%), smoke (75,7%), diabetes (56,3%) and dyslipidemia (54,4%). At baseline 33% of selected patients presented coronary vascular disease, 34% carotid atherosclerosis and 44,7% chronic renal failure. Within 5 years follow-up 24 patients (23,3%) underwent a further revascularization on treated vascular axis, and 24 patients (23,3%) underwent revascularization on controlateral vascular axis. 48 patients (46.6%) remained asymptomatic after 5 years from revascularization. During 5 years follow-up new-diagnosed major cardiovascular events (MI and ischemic stroke) were reported in 34 patients with PAD (33%). Mortality rate for cardiovascular events was 25,3%, 8,7% for non-vascular events. The incidence of major cardiovascular events was significantly higher in diabetic (n=58, 56,3%) vs non diabetic patients (41,4% vs 22,2%, p<0.05). Furthermore, in the 5-years follow-up higher mortality rate was observed in diabetic (20,7%) vs. non diabetic patients (11,1%, NS). In conclusion, our long-term (5 years) follow-up data indicate a good rate of clinical success of endovascular revascularization in almost 50% of patients. In more than 40% of patients a second revascularization was indicated within 5 years. Diabetic patients are prone to higher risk of involvement of different vascular sites, new cardiovascular events and mortality. Efforts towards increasing awareness to assess morphofunctional conditions of coronary and carotid circulation, together with intensive treatment of the risk factors will help to reduce morbidity and mortality in diabetic patients with PAD.