Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu City, 802-0001, Japan.
BMC Cardiovasc Disord. 2020 Dec 9;20(1):514. doi: 10.1186/s12872-020-01805-6.
This study aimed to reveal the association of diabetes mellitus and dialysis-dependent renal failure with the lesion severity and chronic total occlusion (CTO) in patients undergoing femoropopliteal endovascular therapy for intermittent claudication.
This multicenter retrospective study analyzed the data of 2056 consecutive patients with moderate to severe intermittent claudication, who underwent endovascular therapy for de novo lesions in the superficial femoral artery to the proximal popliteal artery between 2010 and 2018 at five cardiovascular centers in Japan. The association of the clinical characteristics with severity of the lesions, as assessed by the Trans-Atlantic Inter-Society Consensus (TASC) II classification, was investigated using the ordinal logistic regression model. Their association with CTO, lesion length, and severity of calcifications was additionally analyzed using the binomial logistic regression model.
The prevalence of diabetes mellitus and dialysis-dependent renal failure was 54.7% and 21.4%, respectively; 12.5% of the patients had lesions corresponding to TASC II class D, and 39.3% of the patients had CTO. Current smoking and severe claudication were associated with more severe lesions assessed according to the TASC II classification; diabetes mellitus and dialysis dependence were inversely associated with disease severity. The adjusted odds ratios of diabetes mellitus and dialysis dependence were 0.82 (95% confidence interval 0.70-0.97; p = 0.018) and 0.76 (0.62-0.94; p = 0.009), respectively. Diabetes mellitus and dialysis dependence were also inversely associated with CTO (both p < 0.05). Furthermore, diabetes mellitus was inversely associated with a long lesion (p < 0.05). Diabetes mellitus and dialysis dependence were positively associated with severe calcification (both p < 0.05).
Diabetes mellitus and dialysis-dependent renal failure were inversely associated with the lesion severity, as assessed by the TASC II classification, and CTO in patients undergoing femoropopliteal endovascular therapy for intermittent claudication.
本研究旨在揭示糖尿病和透析依赖型肾衰竭与股腘腔内血管重建术治疗间歇性跛行患者的病变严重程度和慢性完全闭塞（CTO）之间的关联。
这项多中心回顾性研究分析了 2010 年至 2018 年间，在日本五家心血管中心，2056 例接受股浅动脉至腘动脉近端腔内治疗的初诊严重间歇性跛行患者的数据。采用有序逻辑回归模型分析了临床特征与病变严重程度（采用跨大西洋内科学会共识（TASC）Ⅱ分类评估）之间的关系。采用二项逻辑回归模型分析了它们与 CTO、病变长度和钙化严重程度之间的关系。
糖尿病和透析依赖型肾衰竭的患病率分别为 54.7%和 21.4%；12.5%的患者病变对应 TASC Ⅱ D 类，39.3%的患者存在 CTO。当前吸烟和严重跛行与 TASC Ⅱ分类评估的更严重病变相关；糖尿病和透析依赖与疾病严重程度呈负相关。糖尿病和透析依赖的调整后比值比分别为 0.82（95%置信区间 0.70-0.97；p=0.018）和 0.76（0.62-0.94；p=0.009）。糖尿病和透析依赖也与 CTO 呈负相关（均 p<0.05）。此外，糖尿病与长病变呈负相关（p<0.05）。糖尿病和透析依赖与严重钙化呈正相关（均 p<0.05）。
糖尿病和透析依赖型肾衰竭与股腘腔内血管重建术治疗间歇性跛行患者的病变严重程度和 CTO 呈负相关。
