Long term outcomes in diabetic patients treated with atherectomy for peripheral artery disease

Background: The prevalence of diabetes has increased significantly in well-developed countries during the last decade and it continues to grow. Diabetes increases the risk of restenosis in patients treated per-cutaneously for peripheral artery disease. The present study sought to compare outcomes of atherectomy treatment in diabetic (DM) vs. non-diabetic (nDM) patients suffering from peripheral artery disease. Method: Between 2008 and 2012, 204 revascularization atherectomy procedures were performed on arteries of the lower extremities. The endpoints included target lesion revascularization (TLR), amputation and death. The type of atherectomy (excisional-soft plaque, orbital-calcified plaque, with active aspiration-with a thrombus) was left to operator discretion. Results: This study contains 132 DM (66% male, age 68±11.2years) and 72 nDM (63% male, age 75±11.3 years) subjects. DM were younger but had a higher prevalence of coronary artery disease (DM: 91% vs. nDM: 62%, p < 0.0001) and end-stage renal disease (DM: 22% vs. nDM: 2.5%, p < 0.0001). There were no differences in critical limb ischemia between the groups (DM: 21% vs. nDM: 12%, p==0.13). Mean time of follow-up was 384 and 411 days in DM and nDM, respectively (p=0.43). There were no significant differences in TLR (DM: 15.2% vs. nDM: 22.2%, p=0.249), amputations (DM: 3.0% vs. nDM: 1.5%, p=NS) or death rates (DM: 2.2% vs. nDM: 2.7%, p=NS). Kaplan-Mayer analysis showed no significant differences between the groups in the time to TLR, amputation or death. Conclusions: Plaque modification with adjusted atherectomy appears to have similar outcomes in diabetic as well as in non-diabetic patients. Nonetheless, a randomized study would be warranted to confirm the findings of the current study.