Impact of pre-operative glycated haemoglobin A1C level on 1-year outcomes of endovascular treatment in patients with critical limb ischemia in the course of diabetes mellitus

Abstract

I n t r o d u c t i o n: Peripheral arterial occlusive disease (PAOD) is a disease with worldwide increasing occurrence. Diabetic patients are greatly exposed on the risk of PAOD and its complications. Th e aim of the study was to check the infl uence of preoperative HbA1C on the outcomes of patients with diabetes undergoing PAOD related endovascular treatment. Mat e r i a l a n d Me t h o d s: Th e study was conducted among 59 patients with PAOD referred from the diabetic foot outpatient for endovascular treatment. Th ey were included in one-year observation based on follow-up visits in 1, 3, 6 and 12 months aft er angioplasty and divided into 2 groups basing on their preoperative glycaemia. Th e clinical condition of the lower limbs was assessed by use of the Rutherford classifi cation, ankle-brachial index (ABI) and toe-brachial index (TBI). Changes in patients’ quality of life (QoL) were also evaluated. R e s u l t s: Reintervention within 12 months were less frequent in patients with HbA1C ≤8.0% than in HbA1C >8.0% patients (9.09% vs. 35.48%, p = 0.03). TBI of the treated limb was lower in patients with elevated than in patients with proper glycaemia at 6 month [0.2 (0.0–0.38) vs. 0.38 (0.31–0.46); p <0.008] 50 Agnieszka Wachsmann, Mikołaj Maga, et al. and 12 month follow-up [0.17 (0.0–0.27) vs. 0.32 (0.25–0.38); p <0,001]. Th e rate of healed ulcerations aft er 6 months was higher in patients HbA1C ≤8.0% (45.0% vs. 16.13%; p = 0.02) and they had signifi cantly greater improvement of QoL. C on c l u s i o n: Results of this study shows that preoperative level of glycaemia is an important factor for long-term prognosis in diabetic patients with PAOD. Elevated HbA1C level decreases signifi cantly long-term improvement of QoL in DM patients undergoing endovascular treatment.