Can We Predict Outcome of Endovascular Tibial Interventions for Critical Limb Ischemia in Diabetic Patients

Objective: Determine efficacy of endovascular tibial level interventions for critical limb ischemia (CLI) in a diabetic population . Determine factors that help predict which diabetic patients benefit from such interventions.
Methods: Retrospective review of diabetic patients undergoing endovascular therapy of crural vessels by a vascular surgeon. Improvement in clinical status was defined as healing of ulcer or gangrene or resolution of rest pain(RP).
Results: Endovascular tibial level interventions for CLI were undertaken in 86 limbs. Limb salvage was 78%, however, clinical improvement was noted in only 53% of patients. No procedure led directly to amputation. There were no mortalities related to the procedures.
ABIs were unable to be assessed in 45.6% of patients secondary to non-compressible vessels. TBIs were unable to be assessed in 1/3 of patients, due to foot level amputations. Patients who were undergoing intervention for gangrene as opposed to RP or ulcers were at increased risk for major amputation (p=.016).
Univariate analysis did not predict clinical improvement or need for amputation with respect to use of insulin, presence of ESRD, significant change in ABI or TBI, concomitant supratibial procedure, nor number of vessels treated.
Conclusion: Endovascular interventions on crural vessels do not appear to be as successful in diabetic patients as in non diabetics as previously reported in the literature. Predictors of which diabetic patients will benefit from endovascular intervention are difficult to elucidate. ABIs and TBIs do not apply to a significant portion of this population. Better methods of determining hemodynamic improvement in diabetics need to be developed.