Endocrine Abstracts

Objective: To analyse features of peripheral artery disease (PAD) in patients with diabetes mellitus (DM), to determine the consequences of PAD and the risk factors for amputation.

Material and methods: Retrospective study of 925 diabetic patients (58% males, 95.6% with type 2 DM) with PAD treated in Vascular Surgery Centre in Vilnius City University Hospital in 1997–2011 was performed.

Results: Mean age was 67.99±9.47 years; mean duration of having DM was 12.95±9.91 years. 47.8% of patients had diabetic angiopathy, 34.9% – nephropathy, 14.6% – retinopathy and 33.7% – polyneuropathy. On admission to the hospital 56.5% of patients had intermittent claudication or permanent leg pain, 82.5% had foot defects, including gangrene or ulcer. 30% T1DM patients and 43.2% T2DM patients with foot defects were painless.

Three hundered and sixty nine patients underwent amputation: 53.4% fingers’ amputations, 29.3% below-knee amputations and 17.3% above-knee amputations. Bypass surgery was performed in 360 (39%) patients; revascularization angioplasty procedure (PTA) had 155 (17%) patients.

An average lengh of stay in hospital was 17.3±10.80 days. Mean length of stay in the amputees group was 18.35±10.39 days and it was by 2.35 days longer than after bypass surgery (P=0.012) and 8.9 days longer than after PTA (P<0.0001). Patients without leg’s pain were treated by 1.67 days longer than those who suffered pain (P=0.014).

Previous amputation or bypass surgery predicted new amputation (accordingly odds ratio 3.15 and 1.87), but decreased accordingly 2.17 and 1.49 times odds for bypass surgery.

Conclusions: PAD predominated in male patients, age above 60 years, with T2DM, with duration of diabetes more than 10 years and multiple diabetes complications. 39.9% of the diabetic patients with PAD underwent amputations. Patients with amputation stayed in hospital longer than those with bypass surgery or PTA. Previous amputation and bypass surgery were independent risk factors for limb amputation in diabetes patients.