Long-term prognosis of diabetic patients with critical limb ischemia: A population-based cohort study

Abstract

Objective- To evaluate the long-term prognosis of critical limb ischemia (CLI) in diabetic patients.

Research design and methods- 564 consecutive diabetic patients were hospitalized for CLI from January 1999 to December 2003; 554 were followed until December 2007.

Results- The mean follow up was 5.93 ± 1.28 years. Peripheral angioplasty (PTA) was performed in 420 (74.5%) and bypass graft (BPG) in 117 (20.6%) patients. Neither PTA nor BPG were possible in 27 (4.9%) patients. Major amputations were performed in 74 (13.4%) patients; 34 (8.2%) in PTA, 24 (21.1%) in BPG, and 16 (59.2%) in no revascularized group. Restenosis occurred in 94 patients; bypass failures in 36 patients and recurrent ulcers in 71 patients . CLI was observed in the contralateral limb of 225 (39.9%) patients; of these, 15 (6.7%) required major amputations (rate in contralateral compared to initial limb, p = 0.007). 276 (49.82%) patients died. The Cox model showed significant hazard ratios for mortality with: age (HR 1.05 for 1 year, CI 1.03-1.07), unfeasible revascularization (HR 3.06, CI 1.40- 6.70), dialysis (HR 3.00, CI 1.63-5.53), cardiac disease history (HR 1.37, CI 1.05-1.79), and impaired ejection fraction (HR 1.08 for 1 %point, CI 1.05-1.09).

Conclusions- Diabetic patients with CLI have high risks of amputation and death. In a dedicated Diabetic Foot Center, the major amputation, ulcer recurrence, and major contralateral limb amputation rates were low. CAD is the leading cause of death and in patients with CAD history the impaired ejection fraction is the major independent prognostic factor.