Transluminal ballon angioplastics in diabetes mellitus patients with ciritical ischemia of the lower extremities

Objective of the study: to evaluate the early results of endovascular treatment of critical ischemia of the lower extremities (CILE) in patients with diabetes mellitus (DM).

Materials and methods: In the period between November 2004 and November 2007 transluminal ballon angioplastics (TLBAP) was performed 31 times in 30 DM patients with CILE. 20 (66.6%) patients had an ischemic ulcer on the foot, 5 (16.7%) had gangrene, and 5 (16.7%) reported ischemic pain at rest. 25 (83.3%) patients suffered from coronary heart disease, 24 (80%) had hypertension, 14 (46.7%) had cerebrovascular disease, and 8 (26.7%) patients suffered from chronic renal insufficiency. 3 (10%) patients were receiving chronic hemodialysis. The distribution of cases in terms of CILE level and type (according to TASC) was as follows: iliac type A – 1 (3.3%), femoropopliteal type A - 1 (3.3%), type B - 5 (17.2%), typе С - 12 (41.4%), type D - 11 (37.9%), calf arteries type C - 1 (4%), type D - 24 (96%). In 27 (90%) cases, the intervention was carried out on the femoropopliteal segment, in 9 (30%) cases on the tibioperoneal trunk, in 21 (70%) cases on the anterior tibial artery, in 1 (3.3%) case on the posterior tibial artery, and in 13 (43.3%) cases on the peroneal artery. Intraluminal angioplastics was performed in 70%, subintimal angioplastics in 30% of cases.

Results: TLBAP lead to the restoration of magistral blood flow up to the foot through one calf artery in 19 (63.3%) patients, through two arteries in 7 (23.3%) patients and through three arteries in 1 (3.3%) patient. In 3 (10%) cases the treatment was unsuccessful. The results of TLBAP were evaluated 3 months after the operation, a period required for the healing of ulcers. The ulcers were healed in 27 (90%) patients. These patients were categorized according to Rutherford as follows: category 1 -2 (7.4%) patients, category 2-12 (44.4%), category 3 - 8 (29.6%), categories 4 and 5-2 (7.4%) patients in each.

Conclusion: TLBAP was successfully performed in 90% of DM patients, leading to recovery from CILE in 85% of patients.