CHRONIC LIMB THREATENING ISCHEMIA AND DIABETES MELLITUS: THE SEVERITY OF TIBIAL ATHEROSCLEROSIS AND OUTCOME AFTER INFRAPOPLITEAL REVASCULARIZATION

dc.contributorAalto-yliopistofi
dc.contributorAalto Universityen
dc.contributor.authorKoivunen, V.en_US
dc.contributor.authorJuonala, M.en_US
dc.contributor.authorMikkola, Kimmoen_US
dc.contributor.authorHakovirta, H. H.en_US
dc.contributor.departmentDepartment of Computer Scienceen
dc.contributor.organizationTurku University Hospitalen_US
dc.contributor.organizationUniversity of Turkuen_US
dc.date.accessioned2021-02-02T09:10:56Z
dc.date.available2021-02-02T09:10:56Z
dc.date.issued2021-12en_US
dc.description.abstractBackground and Aims: Diabetes mellitus associates with poor outcomes in chronic limb threatening ischemia but data on different hypoglycemic regimens and outcomes are lacking. We analyzed insulin-treated diabetes mellitus, non-insulin-treated diabetes mellitus, and patients without diabetes mellitus. Materials and Methods: All patients with peripheral artery disease and/or diabetes mellitus and infrapopliteal revascularization in the Department of Vascular Surgery, Turku University Hospital during 2007–2015 were included. Tibial atherosclerosis was categorized into crural index classes of I–IV. Results: Of the 497 patients, 180 were insulin-treated diabetes mellitus, 94 non-insulin-treated diabetes mellitus, and 223 patients without diabetes mellitus groups (diabetes mellitus 55.1%). Insulin-treated diabetes mellitus was the most ill, youngest (insulin-treated diabetes mellitus—median: 72.4, interquartile range: 64.0–79.5 versus non-insulin-treated diabetes mellitus—76.0, interquartile range: 67.9–83.6 versus patients without diabetes mellitus—77.3, interquartile range: 68.5–83.7, p < 0.001), had the highest body mass index (insulin-treated diabetes mellitus—median: 27.7, interquartile range: 24.0–31.8 versus non-insulin-treated diabetes mellitus—26.3, interquartile range: 23.2–30.3 versus patients without diabetes mellitus—23.9, interquartile range: 21.5–26.9, p < 0.001), and Charlson comorbidity index (insulin-treated diabetes mellitus—65.6% versus non-insulin-treated diabetes mellitus—46.8% versus patients without diabetes mellitus—10.8%, p < 0.001). After endovascular revascularization, limb salvage was poorer for insulin-treated diabetes mellitus (p = 0.046) and non-insulin-treated diabetes mellitus groups (p = 0.011) compared to surgery, but not for patients without diabetes mellitus (p = 0.15). Patients with crural index IV in insulin-treated diabetes mellitus (p = 0.001) and non-insulin-treated diabetes mellitus (p = 0.013) had higher mortality after revascularization. Crural index IV was a risk factor for limb loss (hazard ratio: 1.37, 95% confidence interval: 1.08–1.74, p = 0.008). Conclusion: Limb salvage after bypass is better for insulin and non-insulin diabetics, compared to the endovascular approach. Extensive tibial atherosclerosis is an independent risk factor for limb loss. It associates with increased mortality in both insulin and non-insulin diabetics.en
dc.description.versionPeer revieweden
dc.format.extent12
dc.format.mimetypeapplication/pdfen_US
dc.identifier.citationKoivunen, V, Juonala, M, Mikkola, K & Hakovirta, H H 2021, ' CHRONIC LIMB THREATENING ISCHEMIA AND DIABETES MELLITUS : THE SEVERITY OF TIBIAL ATHEROSCLEROSIS AND OUTCOME AFTER INFRAPOPLITEAL REVASCULARIZATION ', SCANDINAVIAN JOURNAL OF SURGERY, vol. 110, no. 4, 1457496920968679, pp. 472-482 . https://doi.org/10.1177/1457496920968679en
dc.identifier.doi10.1177/1457496920968679en_US
dc.identifier.issn1457-4969
dc.identifier.otherPURE UUID: 8261cd0d-ae0d-4aa3-88f9-883266a3ed38en_US
dc.identifier.otherPURE ITEMURL: https://research.aalto.fi/en/publications/8261cd0d-ae0d-4aa3-88f9-883266a3ed38en_US
dc.identifier.otherPURE LINK: http://www.scopus.com/inward/record.url?scp=85096506674&partnerID=8YFLogxKen_US
dc.identifier.otherPURE FILEURL: https://research.aalto.fi/files/54879613/SCI_Koivunen_Chronic_limb_threatening_Scandinavian_Journal_of_Surgery.pdfen_US
dc.identifier.urihttps://aaltodoc.aalto.fi/handle/123456789/102581
dc.identifier.urnURN:NBN:fi:aalto-202102021883
dc.language.isoenen
dc.publisherFinnish Surgical Society
dc.relation.ispartofseriesSCANDINAVIAN JOURNAL OF SURGERYen
dc.relation.ispartofseriesarticlenumber 1457496920968679en
dc.rightsopenAccessen
dc.subject.keywordamputationen_US
dc.subject.keywordchronic limb threatening ischemiaen_US
dc.subject.keywordcrural indexen_US
dc.subject.keyworddiabetes mellitusen_US
dc.subject.keywordendovascularen_US
dc.subject.keywordopen surgery bypassen_US
dc.subject.keywordPeripheral artery diseaseen_US
dc.subject.keywordrevascularizationen_US
dc.subject.keywordrisk factoren_US
dc.subject.keywordtibial atherosclerosisen_US
dc.titleCHRONIC LIMB THREATENING ISCHEMIA AND DIABETES MELLITUS: THE SEVERITY OF TIBIAL ATHEROSCLEROSIS AND OUTCOME AFTER INFRAPOPLITEAL REVASCULARIZATIONen
dc.typeA1 Alkuperäisartikkeli tieteellisessä aikakauslehdessäfi
dc.type.versionpublishedVersion
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