Department of Thoracic and Vascular Surgery, Princess Paola Hospital, Vivalia, Marche-en-Famenne, Belgium.
Department of Nephrology and Internal Medicine, Princess Paola Hospital, Vivalia, Marche-en-Famenne, Belgium.
J Endovasc Ther. 2023 Dec;30(6):920-930. doi: 10.1177/15266028221106312. Epub 2022 Jul 2.
To assess the clinical effects of diabetic peripheral neuropathy (DPN) in patients with chronic limb-threatening ischemia (CLTI) treated by primary infrapopliteal angioplasty for neuro-ischemic Rutherford 5, foot wounds.
Over a 10-year period (2009-2019), a series of 304 diabetic ischemic limbs adding or not evincible neuropathic affectation were treated by primary infrapopliteal angioplasty and their files were retrospectively reviewed. Mean length of treated arterial lesions was 6.1 cm (range 1-22 cm). Inferior limb vibration perception threshold diagnostic was performed for comparing and scoring detectable DPN in all studied diabetic patients (classed from 0 to 10 points). There were 19% limbs with normal (0-1 points) perception (group 1), 55% others with "mild" and "moderate" (2-6 points) neuropathic impairment (group 2), and 26% limbs showing "severe" (7-10 points) DPN (group 3).
Primary infrapopliteal angioplasty succeeded in 89% cases in group 1, in 82% in group 2, and in 68% of limbs in group 3. This latest group assembled the heaviest neuropathic affectation and arterial calcifications and proved the lowest clinical benefit at 36 months: 35% (95% confidence interval [CI]=22% to 48%) of primary patency, 36% (95% CI=22% to 50%) wound healing, and 54% (95% CI=39% to 69%) limb preservation rates. A comparison between groups 1 vs 3 and 2 vs 3 of primary patency (p=0.014 and p=0.043), tissue healing (p=0.049 and p=0.01), and limb salvage (p=0.006 and p=0.023) proved significant, yet without statistical weight for group 1 vs 2 (p>0.05). Overall survival was not significantly affected between groups (p=0.34).
The presence of severe DPN may jeopardize the results of infrapopliteal angioplasty in terms of patency, tissue cicatrization, and limb preservation, yet without significance on survival of these patients. When present, DPN requires appropriate stratification as specific indicator in CLTI treatment.
评估原发性腘动脉腔内成形术治疗伴有神经缺血性 Rutherford 5 级足部溃疡的慢性肢体威胁性缺血（CLTI）的糖尿病周围神经病变（DPN）的临床效果。
在 10 年期间（2009-2019 年），对 304 例添加或不添加不可避免的神经病变影响的糖尿病缺血肢体进行了原发性腘动脉腔内成形术治疗，并对其病历进行了回顾性分析。治疗的动脉病变平均长度为 6.1cm（范围 1-22cm）。对所有研究的糖尿病患者进行下肢振动感觉阈值诊断，以比较和评分可检测的 DPN（分为 0-10 分）。19%的肢体感觉正常（0-1 分）（第 1 组），55%的肢体感觉“轻度”和“中度”（2-6 分）神经病变损害（第 2 组），26%的肢体感觉“重度”（7-10 分）DPN（第 3 组）。
第 1 组的原发性腘动脉腔内成形术成功率为 89%，第 2 组为 82%，第 3 组为 68%。第 3 组聚集了最重的神经病变影响和动脉钙化，并在 36 个月时显示出最低的临床获益：原发性通畅率为 35%（95%置信区间[CI]=22%-48%），伤口愈合率为 36%（95%CI=22%-50%），肢体保存率为 54%（95%CI=39%-69%）。第 1 组与第 3 组、第 2 组与第 3 组之间的原发性通畅率（p=0.014 和 p=0.043）、组织愈合（p=0.049 和 p=0.01）和肢体保存（p=0.006 和 p=0.023）的比较均有统计学意义，但第 1 组与第 2 组之间无统计学意义（p>0.05）。各组之间的总体生存率无显著差异（p=0.34）。
重度 DPN 的存在可能会影响到经皮腔内成形术的通畅率、组织愈合率和肢体保存率，但对这些患者的生存率没有影响。当 DPN 存在时，需要进行适当的分层，作为 CLTI 治疗的特定指标。
