Diabetic versus nondiabetic limb-threatening ischemia: outcome of percutaneous iliac intervention

The purpose of this study was to compare the effectiveness of iliac angioplasty and outcomes in diabetic patients and nondiabetic patients with limb-threatening ischemia. Records of 91 consecutive patients with limb-threatening ischemia (rest pain, nonhealing ulceration, or gangrene) who, during a 6-year period, underwent iliac angioplasty of hemodynamically significant lesions were reviewed. Stents were placed in patients with suboptimal findings at angioplasty. Sixty-eight (75%) of the 91 patients were diabetic. Life table analysis and log-rank significance tests were used to compare rates of primary iliac artery patency, primary and secondary graft patency, limb salvage, and survival in diabetic patients versus nondiabetic patients. One hundred seven iliac lesions were treated with percutaneous angioplasty. Ten iliac stents were placed because of suboptimal results at angioplasty. The mean time of follow-up was 20 months (range, 2-62 months). Sixty-eight patients (75%) underwent peripheral reconstruction. Outcomes were comparable in both patient groups for primary iliac patencies at 4 years (diabetic patients, 85%; nondiabetic patients, 76%; p = .5), primary and secondary graft patencies at 4 years (diabetic patients, 65% and 73%, respectively; nondiabetic patients, 74% and 100%, respectively; p = .7 and .19, respectively), 4-year limb-salvage rates (diabetic patients, 93%; nondiabetic patients, 79%; p = .07). Major complications of angioplasty occurred in four patients (4.4%). Outcomes of iliac angioplasty and limb-salvage rates were comparable for diabetic patients and nondiabetic patients who underwent current methods of iliac angioplasty and infrainguinal reconstruction.