Long-term Vascular Restenosis And Risk Factors Of Interventional Therapy For Lower Extremity Arterial Diseases In Type 2 Diabetic Patients

In recent years,the incidence of type 2 diabetes mellitus and associated lower extremity vascular diseases has gradually increased.Atherosclerosis is the main cause of lower extremity vascular disease in type 2 diabetic patients,thus it is also called lower extremity arterial disease(LEAD).The pathology of LEAD mainly contains calcification of middle layer,which is characterized with multilevel,long segments and diffuse lesions and is more common in vessels that below the knee.Therefore,the clinical manifestations of LEAD include pain,intermittent claudication,and even ulcers and limb gangrene.The interventional therapy has become the leading option for the treatment of LEAD,which mainly includes balloon dilatation and stent implantation,and has been proven to be effective,especially for elderly patients with poor general conditions.However,due to the complex pathologies,the long-term patency is still unsatisfying,especially in those with LEAD that below the knee.Besides,there are still limited analysis concerning long-term restenosis and associated risk factors.Therefore,we analyzed the postoperative efficacy,restenosis rate and risk factors of patients with LEAD after interventional therapy,in hoping of improving the prognosis and clinical managements.Subjects and Methods1.SubjectsWe collected the clinical data from 138 patients with LEAD(154 limbs involved)in our department from January,2008 to March,2018,of which included 79 men and 59 women.All the LEAD were diagnosed with digital subtraction angiography(DSA),and had clear indications for interventional therapy.All the patients had signed informed consent.2.MethodsGeneral information of all patients were collected including sex,age,height,weight,smoking history,drinking history,diabetes duration,hypertension duration,history of medication;The clinical symptoms such as pain and intermittent claudication before the intervention therapy were recorded;Glycosylated hemoglobin A1c(HbA1c)?Blood urea nitrogen(BUN)?Serum creatinine(Scr)?Total cholesterol(TC)?Triglyceride(TG)?Low-density lipoprotein Cholesterol(LDL-C)?High-density lipoprotein Cholesterol(HDL-C)?Alanine aminotransferase(ALT)?Aspertate aminotransferase(AST)?High-sensitive C-reactive protein(hs-CRP)were measured;Ankle brachial index(ABI),toe brachial index(TBI)and other test results were recorded.According to the results of DSA,the treatments were performed,including balloon dilatation or stent implantation,.Patients were followed up at 1,3,6,12 months after the interventional therapy,the clinical symptoms and complications were monitored and recorded;HbA1c,liver function,renal function,blood lipids and hs-CRP were measured;ABI and TBI were recorded;Computed tomographic angiograph(CTA)or ultrasound examination were further performed to assess the restenosis of lower extremity blood vessels if the ABI decreased or the symptoms relapsed.Then we analyzed clinical effect and restenosis rate of interventional therapy in patients with LEAD.Results1.Interventional therapy was performed in 138 patients(154 limbs involved).The HDL-C,LDL-C,hs-CRP,and Hb A1 c were significantly improved after interventional therapy(P<0.05).At 1,3,6 and 12 months after the operation,the ABI and TBI were significantly improved(P<0.01).The total restenosis rates were 17.6%,17.8%,20% and 20.9% at 1,3,6 and 12 months after the operation,respectively.2.All the patients were divided according to the interventional site: above-knee group(n=29,aged 68.48±9.14 years,20 men),below-knee group(n=54,aged 72.17±6.94 years,28 men)and the mixed group(n=71,aged 72.18±8.16 years,39 men).The restenosis rate of above-knee group were 8.3%,7.7%,5.6%,23.1% at 1,3,6 and 12 months after operation,as compared with 37.5%,30%,37.5%,30.8% in below-knee group and with 7.9%,15.0%,14.0% and 10.7% in the mixed group.The restenosis rate in the below-knee group was significantly higher than that in the above-knee group and the mixed group at 1 month and 6 months after operation(37.5% vs 8.3% vs 7.9%,37.5% vs 5.6% vs 14.0%,P<0.05).3.All the patients were divided according to the interventional approaches: balloon dilatation group(n=65,aged 72.31±6.80 years,32 men)and stent implantation group(n=89,aged 70.88±8.81 years,55 men).The restenosis rate of balloon dilatation group were 32.1%,28%,34.2%,28.6% at 1,3,6 and 12 months after operation,as compared with 8.7%,12.5%,11.3%,15.4% in the stenting group.The restenosis rate in the balloon dilatation group was significantly higher than that in stent implantation group at 1 month and 6 months after operation(32.1% vs 8.7%,34.2% vs 11.3%,P<0.05).4.Multivariate logistic regression analysis showed that the preoperative TC was the independent risk factor of interventional therapy efficacy(OR=0.356,95% CI:0.143-0.883,P=0.026).Besides,the preoperative HbA1 c was the independent risk factor of restenosis(OR=1.348,95% CI:1.013-1.794,P=0.040)Conclusion1.Interventional therapy could significantly improve lower limb perfusion in patients with LEAD.2.The incidence of Long-term vascular restenosis rate was associated with the operation sites and approaches.The restenosis rate in the below-knee group was significantly higher than that in the above-knee group and the mixed group.The restenosis rate in the balloon dilatation group was significantly higher than that in stent implantation group.3.The higher the preoperative TC,the worse the interventional therapy efficacy.The higher the preoperative HbA1 c,the greater the risk of restenosis.Therefore,efficacious control for blood glucose,blood lipids and other metabolic indicators could improve the prognosis of interventional therapy and reduce the restenosis rate.