Journal Article

Comparison of Outcomes After Revascularization for Acute Lower Limb Ischemia in Patients with and without Type 2 Diabetes Mellitus – A Nationwide Registry Study

Drake, Isabel, Carlsen, Hanne Krage, Karonen, Emil, Eliasson, Björn, Acosta, Stefan, Gottsäter, Anders, Eek, Frida, Butt, Talha

2025

Overview

Acute lower limb ischemia (ALI) is a life and limb threatening event often affecting patients with type 2 diabetes mellitus (T2DM). Little is known about how T2DM affects the risk of adverse events in patients revascularized for ALI. This study aimed to investigate if there were differences in major outcomes between ALI patients with and without T2DM. Between 2010 and 2014, 615 patients underwent revascularization for ALI, according to the Swedish Vascular Registry (SWEDVASC). Using the National Diabetes Registry (NDR), 245 (39.8%) of the patients were identified as having T2DM. Uni- and multivariable Cox or logistic regression analyses were performed to evaluate risk differences for major amputation, mortality, major adverse cardiovascular events (MACE), and fasciotomy between patients with and without T2DM. The rates of major amputation and mortality at one year were 32.7% and 21.6% in the T2DM group, compared to 21.9% and 31.9% in the non-DM group, respectively, resulting in a hazard ratio (HR) of 1.52 (95% confidence interval [CI] 1.12-2.07) for major amputation and HR of 0.64 (95% CI 0.46-0.88) for mortality. At one year, the HR for major amputation was 1.45 (95% CI 0.99-2.11), HR for mortality 0.92 (95% CI 0.61-1.39), HR for combined major amputation/mortality 1.27 (95% CI 0.94-1.72), and HR for MACE 1.24 (95% CI 0.92-1.67) for those with T2DM compared to those without in the multivariable Cox-regression analyses. The multivariable logistic regression analysis showed significantly lower odds of fasciotomy, OR 0.1 (95% CI 0.01-0.51) in the T2DM-group. T2DM was not significantly associated with higher hazard of major amputation, mortality, combined major amputation/mortality, or MACE after revascularization for ALI, compared to patients without T2DM. Patients with T2DM had significantly lower odds of fasciotomy.

• Publisher: Dove Medical Press Limited,Dove Press,Dove,Dove Medical Press
• Subject: Acute Disease / acute lower limb ischemia / Aged / Aged, 80 and over / Amputation, Surgical / Analysis / Cardiology and Cardiovascular Disease / Care and treatment / Chi-Square Distribution / Clinical Medicine / Complications and side effects / Diabetes Mellitus, Type 2 - diagnosis / Diabetes Mellitus, Type 2 - mortality / Endovascular Procedures - adverse effects / Endovascular Procedures - mortality / Fasciotomy / Female / Humans / Ischemia / Ischemia - diagnosis / Ischemia - diagnostic imaging / Ischemia - mortality / Ischemia - surgery / Ischemia - therapy / Kardiologi och kardiovaskulära sjukdomar / Klinisk medicin / Limb Salvage / Logistic Models / Lower Extremity - blood supply / major amputation / Male / Medical and Health Sciences / Medical research / Medicin och hälsovetenskap / Medicine, Experimental / Middle Aged / Multivariate Analysis / Odds Ratio / Original Research / Patient outcomes / Peripheral Arterial Disease - diagnosis / Peripheral Arterial Disease - diagnostic imaging / Peripheral Arterial Disease - mortality / Peripheral Arterial Disease - surgery / Peripheral Arterial Disease - therapy / Proportional Hazards Models / Registries / Retrospective Studies / Risk Assessment / Risk Factors / Sweden - epidemiology / Time Factors / Treatment Outcome / Type 2 diabetes / type 2 diabetes mellitus / Vascular Surgical Procedures - adverse effects / Vascular Surgical Procedures - mortality