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Jan Apelqvist

Physician

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Outcome of intra-arterial thrombolysis in patients with diabetes and acute lower limb ischemia : a propensity score adjusted analysis

Author

  • Talha Butt
  • Anders Gottsäter
  • Jan Apelqvist
  • Gunnar Engström
  • Stefan Acosta

Summary, in English

The presence of diabetes mellitus is rarely addressed in acute lower limb ischaemia (ALLI). The aim of this study was to evaluate the outcome of local intra-arterial thrombolysis for ALLI in patients with diabetes mellitus (DM). Outcome of all thrombolytic events performed in an endovascular first-strategy centre during a 13-year period between 2001 and 2013 in patients with ALLI were followed to January 2017. A propensity score adjusted analysis was performed to evaluate results in patients with (n = 83) versus without (n = 316) DM. Patients with DM were younger (p = 0.001), more often women (p = 0.014), more often had renal insufficiency (p = 0.041), foot ulcers (p < 0.001), and thrombosis (p = 0.032) than the patients without DM. At presentation, patients with DM had a lower degree of ischemia judged by the Rutherford classification, compared to those without DM (p = 0.023). None of the 83 diabetic patients had a popliteal artery aneurysm, compared to 25 (7.9%) of the 316 patients without DM (p = 0.008). The amount of tPA administered to patients with DM was higher than to patients without DM (p = 0.03). In the propensity score adjusted analysis, patients with DM had a higher rate of major amputation at 1 (OR 2.52; 95% CI 1.22–5.20) and 3 years (OR 2.52; 95% CI 1.26–5.04), and a lower amputation-free survival at 3 years (OR 0.46; 95% CI 0.25–0.85), than those without DM. Patients with DM presenting with ALLI differ in clinical characteristics, presentation, and aetiology compared to patients with DM, and have a higher rate of major amputation and lower amputation-free survival rate after intra-arterial thrombolysis.

Department/s

  • Department of Clinical Sciences, Malmö
  • EpiHealth: Epidemiology for Health

Publishing year

2017-10-04

Language

English

Pages

475-480

Publication/Series

Journal of Thrombosis and Thrombolysis

Volume

44

Issue

4

Document type

Journal article

Publisher

Springer

Topic

  • Endocrinology and Diabetes
  • Cardiac and Cardiovascular Systems

Keywords

  • Acute lower limb ischemia
  • Diabetes mellitus
  • Propensity score adjusted analysis
  • Thrombolysis

Status

Published

ISBN/ISSN/Other

  • ISSN: 0929-5305