Predictors of outcome in diabetic patients undergoing infrapopliteal endovascular revascularisation for chronic limb-threatening ischaemia

ABSTRACT OBJECTIVE The incidence of chronic limb-threatening ischaemia in diabetic patients is increasing. The factors influencing outcome following infrapopliteal revascularisation in these patients is largely unknown. Therefore, this study aims to identify the impact of perioperative glucose control on the long-term outcomes in this patient cohort, and furthermore to identify other factors independently associated with outcome. METHODS Consecutive diabetic patients undergoing infrapopliteal endovascular revascularisation for chronic limb-threatening ischaemia were identified. Patients' demographics, procedural details, daily capillary blood glucose and haemoglobin A1C levels were collected and analysed against the study endpoints using Kaplan-Meier and Cox regression analysis. RESULTS 437 infrapopliteal target-vessels were successfully crossed in 203 patients. Amputation free survival by Kaplan Meier (Estimate (SE)%) was 74 (3.3)% and 63 (3.7)%, primary patency was 61 (4.2)% and 50 (4.9)%, assisted-primary patency was 69 (5.2)% and 55 (6.1)% and secondary patency was 71(3.8)% and 59 (4.1) % at 1 year and 2 years respectively. Cox regression analysis showed high perioperative capillary blood glucose levels to be an independent predictor of binary restenosis (HR 1.49 (95% CI 1.31-1.1.78) P=0.015). Post-procedural dual-antiplatelet-therapy was found to be an independent predictor of amputation free survival (HR 1.69 (1.04-2.75), P=0.033) and freedom from major adverse limb events (HR 1.96 (1.16-3.27) P=0.023) and baseline eGFR was significantly associated to better amputation free survival (HR 0.52 (0.31-0.87), P=0.014). CONCLUSION Poor perioperative glycaemic control is associated with a higher incidence of restenosis after infrapopliteal revascularisation in diabetic patients. Dual antiplatelet therapy is associated with better outcomes in this group.