| ObjectiveThe diabetic lower limbs’ angiopathy is a common complication of diabetes.And now,it has been the main reason for diabetic amputated extremity.Clinical interventions mainly include internal medicine,surgery,catheterization operation and so on.Recently,interventional therapy has been carried out in clinic,but after intervention its therapeutic effect especially the long-term effect is still controversial.This study aims to approach the therapeutic effect of diabetic lower limbs’ angiopathy interventional therapy and its relational risk factors,and expects to provide clinical guidance.MethodsWe selected 71 cases of type Ⅱ diabetics with lower extremity venous disease who were admitted in the endocrinology and vascular surgery department of Qilu Hospital from January 2006 to Decembe 2015.We collected patients’ medical records and followed up,these data included:sex,age,weight,body mass index(BMI),and ankle brachial index(ABI);History:course of diabetes,course of hypertension,course of cerbral infarction,course of coronary atherosclerosis and smoking history;Laboratory index:low density lipoprotein,high density lipoprotein,triglyceride,total cholesterol,creatinine,carbamide,acidum uricum,glycosylated hemoglobin,urine microalbumin and so on.We gathered patients to the Qilu Hospital for free sonography of the lower extremity arteriovenous.Then we analyzed the intervention postoperatively patency rates of lower limb vascular for diabetic lower extremity vascular disease patients 1,2,3,5,7 years after intervention.We analyzed the amputation rate and all-cause mortality,then approached the possible related risk factors which affected the curative effect of lower extremity vascular interventional therapyResultsIn this research,71 patients with diabetes accepted interventional therapy in vessels of lower limbs were followed up with the longest time of 8 years,the shortest time of 1 year and average time of 2.8 years.10 patients were lost to follow up with the rate of 14.08%.Eventually 61 patients were brought into this study.41 of them were male,20 of them were female and the gender ratio was 2:1.The average age was 68.11±8.88 with the oldest of 84 years old and youngest of 49 years old.3 patients were under 50 years old accounted for 4.90%.12 patients were 51-60 years old accounted for 19.70%.21 patients were 61-70 years old accounted for 34.40%.21 patients were 71-80 years old accounted for 34.40%.4 patients were above 80 years old accounted for 6.60%.See Table 1 and Figure 1.1.According to the Fontaine grading method,10 cases were in level Ⅰ,13 cases were in level Ⅱ,18 patients were in level III,20 patients were in level IV.The statistical analysis results of every group’s information showed that no significant statistic difference was found among the factors of age,gender and course of hypertension(P>0.05),while the difference of smoking history,FPG,LDL-C,CRP,urinary albumin,Hcy showed statistical significance(P<0.05).See Table 2.2.According to the grading method made by Trans-Atlantic Inter-Societal Consensus(TASC)on the degree of lower limbs’ arteriosclerosis,61 diabetic patients with vascular diseases in their lower limbs were divided into 4 degrees of A,B,C,D.The statistical analysis on these four groups showed that the gender and age distribution was balanced,no significant difference was found among the factors of creatinine,urea nitrogen,course of diabetes and other metabolic indexes(P>0.05),while smoking history,LDL-C,CRP,urinary albumin and Acy showed statistic difference(P<0.05).See Figure 2,Figure 3 and Table 3.3.During the follow-up period,11 patients,including 7 males and 4 females,acceptedamputation surgery with the total amputation rate of 18.03%.Patients with vascular diseases in lower limbs were divided into 4 groups according to TASC’s grading method.During the follow-up period,1 patients accepted amputation surgery in group A,2 in group B,4 in group C,4 in group D,with the respective proportions in each group of 4.34%,11.76%,36.36%,40.00%.The statistical analysis showed that no statistical significance was found between group A and group B on amputation rate(P>0.05),while statistical significance was found between group C,group D and group A,group B(P<0.05).See Table 4 and Figure 4.4.During the follow-up period,9 patients passed away including 5 males and 4 females with the all-cause mortality rate of 14.70%.2 patients died from myocardial infarction,1 died from lung cancer,1 died from pulmonary infection,1 died from multiple organ failure,1 died from allergic shock and invalid rescue,3 died from unknown causes.In these death cases,6 of them survived for 5 years with interventional therapy accounted for 67.67%,5 of them survived for more than 5 years accounted for 33.33%.5.For these 61 diabetic patients with vascular diseases in their lower limbs,5 of them had occlusion in iliac arteries accounted for 8.20%,8 of them had occlusion in common femoral arteries accounted for 13.11%,13 of them had occlusion in deep femoral arteries accounted of 21.31%,14 of them had occlusion in superficial femoral arteries accounted for 22.92%,10 of them had occlusion in popliteal arteries accounted for 16.39%,5 of them had occlusion in anterior tibial arteries accounted for 8.20%,6 of them had occlusion in posterior tibial arteries accounted for 9.83%.In the first follow-up year,30 patients kept patency in original occluded sites with the patency rate of 49.18%.In the second year,22 patients kept patency with the rate of 36.07%.In the third year,21 patients kept patency with the rate of 34.43%.In the fifth year,11 patients kept patency with the rate of 18.03%.In the eighth year,6 patients kept patency with the rate of 9.83%.With the time of interventional therapy becoming longer,the probability of vascular restenosis would increase.See Figure 5 and Figure 6.6.According to the occurrence of vascular restenosis after one year’s interventional therapy,the patients were divided into restenosis group(n=31)and non-restenosis group(n=30).Binary logistic regression analysis was conducted on the factors of age,gender,HbAlc,urinary albumin,course of diabetes,hypertension,smoking history,cerebral infarction,coronary heart disease,blood fat,Hcy and CRP.Then forward selection was adopted as the variable screen method with the selection criteria of 0.05 and the rejection criteria of 0.10,the analysis results of which showed that urinary albumin,Hcy and CRP were the independent influence factors on restenosis after interventional therapy.See Table 5,Table 6,Table 7 and Table 8.Conclusion1.Smoking history,blood glucose and blood fat have influences at some level on the occurrence and development of vascular diseases in lower limbs of diabetic patients.The worse vascular diseases become,the higher of CRP and Hcy levels would be.2.With the longer time of interventional therapy,the probability of restenosis in lower limbs would increase.Urinary albumin,CRP and Hey are the independent influence factors of vascular restenosis.Reducing the excretion of urinary albumin and maintaining CRP and Hcy at a relatively lower level could decrease the occurrence of restenosis at some level,while the specific mechanism of restenosis after interventional therapy still requiring further investigation.3.Interventional therapy could preferably improve the occlusion state in vessels of patients’ lower limbs.The prevention of restenosis in long-term treatment should be the top clinical priority. |
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