Early and Five-year Amputation and Survival Rate of Diabetic Patients with Critical Limb Ischemia: Data of a Cohort Study of 564 Patients

Objective

To evaluate the early and late major amputation and survival rates and related risk factors in diabetic patients with critical limb ischemia (CLI).

Design

Retrospective study.

Methods

Revascularization feasibility, major amputation, survival rate and related risk factors were recorded in 564 diabetic patients consecutively hospitalized for CLI from 1999 to 2003 and followed until June 2005.

Results

Peripheral angioplasty (PTA) was carried out in 420 (74.5%), bypass graft (BPG) in 117 (20.7%) patients. In 27 (4.8%) patients both PTA and BPG were not possible. Twenty-three above-the-ankle amputations (4.1%) were performed at 30 days: 6 in PTA patients, 3 in BPG patients, 14 in non revascularized patients. In the follow-up of 558 patients (98.9%), 62 repeated PTAs and 9 new BPGs, 32 new major amputations (16 in PTA patients, 14 in BPG patients and 2 in non-revascularized patients) were performed. Major amputation was associated with absence of revascularization (OR 35.9, p<0.001, CI 12.9–99.7), occlusion of each of the three crural arteries (OR 8.20, p=0.022, CI 1.35–49.6), wound infection (OR 2.1, p=0.004 CI 1.3–3.6), dialysis (OR 4.7, p=0.001 CI 1.9–11.7) increase in TcPO₂ after revascularization (OR 0.80, p<0.001 CI 0.74–0.87).

One hundred seventy three patients died during follow-up and this was associated with age (HR 1.05, p<0.001 CI 1.03–1.07), history of cardiac disease (HR 2.16, p<0.001 CI 1.53–3.06), dialysis (HR 3.52, p<0.001 CI 2.08–5.97), absence of revascularization (HR 1.68, p<0.001, CI 1.29–2.19) and impaired ejection fraction (HR 1.08, p<0.001, CI 1.05–1.09).

Conclusions

In diabetic patients with CLI the revascularization is feasible in most cases and allows a low rate of early major amputation. This rate is higher in the follow-up period. Major amputation is very high in patients where revascularization is not feasible while the high mortality rate is due to the serious comorbidities observed in these patients.

Keywords: Diabetic foot, Critical limb ischemia, Peripheral angioplasty, Peripheral bypass graft, Above-the-ankle amputation, Survival