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Martinez OP, Storo K, Provenzano Z, Murphy E, Tomita TM, Cox S. A systematic review and meta-analysis on the influence of sociodemographic factors on amputation in patients with peripheral arterial disease. J Vasc Surg 2024; 79:169-178.e1. [PMID: 37722513 DOI: 10.1016/j.jvs.2023.08.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To identify disparities in sociodemographic factors that are associated with major lower limb amputation in patients with peripheral arterial disease (PAD). METHODS A systematic review of the literature was performed to identify studies that reported major lower limb amputation rates in patients with PAD among different sociodemographic groups. Data that compared amputation rates on the basis of sex, race, ethnicity, income, insurance, geography, and hospital type were collected and described. Outcomes were then aggregated and standardized, and a meta-analysis was performed to synthesis data into single odds ratios (ORs). RESULTS Forty-one studies were included in the review. There was no association found between males and females (OR, 0.95; 95% confidence interval [CI], 0.90-1.00). Compared with Whites, higher rates of amputation were seen among Blacks/African Americans (OR, 2.02; 95% CI, 1.81-2.26) and Native Americans (OR, 1.22; 95% CI, 1.04-1.45). No significant association was found between Whites and Asians, Native Hawaiians, or Pacific Islanders (OR, 1.15; 95% CI, 1.00-1.33). Hispanics had higher rates of amputation compared with non-Hispanics (OR, 1.36; 95% CI, 1.22-1.52). Compared with private insurance, higher rates of amputation were seen among Medicare patients (OR, 1.38; 95% CI, 1.27-1.50), Medicaid patients (OR, 1.59; 95% CI, 1.44-1.76), and noninsured patients (OR, 1.41; 95% CI, 1.02-1.95). Compared with the richest income quartile, higher rates of amputation were seen among the second income quartile (OR, 1.10; 95% CI, 1.05-1.15), third income quartile (OR, 1.20; 95% CI, 1.07-1.35), and bottom income quartile (OR, 1.36; 95% CI, 1.24-1.49). There was no association found between rural and urban populations (OR, 1.35; 95% CI, 0.92-1.97) or between teaching and nonteaching hospitals (OR, 1.01; 95% CI, 0.91-1.12). CONCLUSIONS Our study has identified a number of disparities and quantified the influence of sociodemographic factors on major lower limb amputation rates owing to PAD between groups. We believe these findings can be used to better target interventions aimed at decreasing amputation rates, although further research is needed to better understand the mechanisms behind our findings.
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Affiliation(s)
- O Parker Martinez
- University of South Carolina School of Medicine Columbia, Columbia, SC.
| | - Katharine Storo
- University of South Carolina School of Medicine Columbia, Columbia, SC
| | | | - Eric Murphy
- University of South Carolina School of Medicine Columbia, Columbia, SC
| | - Tadaki M Tomita
- Department of Surgery, Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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Paraskevas KI, Mukherjee D, Papas TT. Benefits of Statins and Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK-9) Inhibitors for Patients with Peripheral Arterial Disease. Curr Vasc Pharmacol 2024; 22:8-10. [PMID: 38037835 DOI: 10.2174/0115701611292747231129080204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Kosmas I Paraskevas
- Department of Vascular Surgery, Red Cross Hospital, Athens, Greece
- Department of Vascular Surgery, Central Clinic of Athens, Athens, Greece
| | - Debabrata Mukherjee
- Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, U.S.A
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Paraskevas KI, Veith FJ. Expansion of Bypass as a Revascularization Option for Patients With Chronic Limb-Threatening Ischemia. Angiology 2023; 74:809-811. [PMID: 36880697 DOI: 10.1177/00033197231162707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
| | - Frank J Veith
- Division of Vascular Surgery, New York University Langone Medical Center, New York, NY, USA
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA
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Foussard N, Dari L, Ducasse E, Rigalleau V, Mohammedi K, Caradu C. Lower-limb peripheral arterial disease and amputations in people with diabetes: Risk factors, prognostic value and management. Presse Med 2023; 52:104164. [PMID: 36863662 DOI: 10.1016/j.lpm.2023.104164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/20/2022] [Accepted: 02/17/2023] [Indexed: 03/04/2023] Open
Abstract
Lower-limb peripheral arterial disease (PAD), is a common manifestation of systemic atherosclerosis, resulting from a partial or complete obstruction of at least one lower-limb arteries. PAD is a major endemic disease with an excess risk of major cardiovascular events and death. It also leads to disability, high rates of lower-limb adverse events and non-traumatic amputation. In patients with diabetes, PAD is particularly frequent and has a worse prognosis than in patients without diabetes. The risk factors of PAD are comparable to those for cardiovascular disease. The ankle-brachial index is usually recommended to screen PAD despite its limited performance in patients with diabetes, affected by the presence of peripheral neuropathy, medial arterial calcification, incompressible arteries and infection. Toe brachial index and toe pressure emerge as alternative screening tools. The management of PAD requires strict control of cardiovascular risk factors including diabetes, hypertension and dyslipidaemia, the use of antiplatelet agents and lifestyle management, to reduce cardiovascular adverse events, but few randomized controlled trials have evaluated the benefits of these treatments in PAD. Several advances have been achieved in endovascular and surgical revascularization procedures, with obvious improvement in PAD prognosis. Further studies are required to increase our understanding of the pathophysiology of PAD and to evaluate the interest of different therapeutic strategies in the occurrence and progression of PAD in patients with diabetes. Here, we present a narrative and contemporary review to synthesize the key epidemiology findings, screening and diagnosis methods, and major therapeutic advances regarding PAD in patients with diabetes.
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Affiliation(s)
- Ninon Foussard
- Bordeaux University Hospital, Hôpital Haut-Lévêque, Department of Endocrinology, Diabetes and Nutrition, Pessac, France; University of Bordeaux, Faculty of Medicine, Bordeaux, France; INSERM unit 1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Loubna Dari
- University of Bordeaux, Faculty of Medicine, Bordeaux, France; Bordeaux University Hospital, Hôpital Saint-André, Vascular Medicine Department, Bordeaux, France
| | - Eric Ducasse
- University of Bordeaux, Faculty of Medicine, Bordeaux, France; INSERM unit 1034, Biology of Cardiovascular Diseases, Pessac, France; Bordeaux University Hospital, Department of Vascular Surgery, Bordeaux, France
| | - Vincent Rigalleau
- Bordeaux University Hospital, Hôpital Haut-Lévêque, Department of Endocrinology, Diabetes and Nutrition, Pessac, France; University of Bordeaux, Faculty of Medicine, Bordeaux, France
| | - Kamel Mohammedi
- Bordeaux University Hospital, Hôpital Haut-Lévêque, Department of Endocrinology, Diabetes and Nutrition, Pessac, France; University of Bordeaux, Faculty of Medicine, Bordeaux, France; INSERM unit 1034, Biology of Cardiovascular Diseases, Pessac, France.
| | - Caroline Caradu
- Bordeaux University Hospital, Department of Vascular Surgery, Bordeaux, France
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Glazkova P, Glazkov A, Kulikov D, Zagarov S, Kovaleva Y, Babenko A, Kononova Y, Kitaeva E, Britvin T, Mazur N, Larkov R, Rogatkin D. Incoherent Optical Fluctuation Flowmetry: A New Method for the Assessment of Foot Perfusion in Patients with Diabetes-Related Lower-Extremity Complications. Diagnostics (Basel) 2022; 12:diagnostics12122922. [PMID: 36552929 PMCID: PMC9776794 DOI: 10.3390/diagnostics12122922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
Abstract
(1) Background: To date, there are no studies evaluating the ability of the incoherent optical fluctuation flowmetry (IOFF) method to assess foot tissue perfusion. The aim of this study was to evaluate the correlation between perfusion values measured by IOFF and TcPO2 in patients with diabetes-related lower-extremity complications. (2) Methods: This was an observational, cross-sectional, two-center study. Diabetic patients with peripheral artery disease and/or diabetic foot ulcers were studied (n = 27, examinations were carried out on 54 legs). Perfusion in the foot tissues was assessed using TcPO2 (reference standard for this study) and the IOFF method. (3) Results: High correlation coefficients of all perfusion parameters measured by IOFF with TcPO2 (Rs 0.7 to 0.76) were shown. The study demonstrated that the IOFF method allows, with a sensitivity of 85.7% and a specificity of 90.0%, the identification of patients with a critical decrease in TcPO2 < 20 mmHg. (4) Conclusions: The high correlation of IOFF parameters with TcPO2 and the moderately high sensitivity and specificity in detecting patients with severe ischemia of foot tissues shows the promise of the method for assessing a tissue perfusion in patients with diabetes-related lower-extremity complications.
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Affiliation(s)
- Polina Glazkova
- Moscow Regional Research and Clinical Institute (“MONIKI”), 129110 Moscow, Russia
- Correspondence:
| | - Alexey Glazkov
- Moscow Regional Research and Clinical Institute (“MONIKI”), 129110 Moscow, Russia
| | - Dmitry Kulikov
- Medical Faculty, Moscow Region State University, 141014 Mytishchi, Russia
- N.A. Semashko National Research Institute of Public Health, 105064 Moscow, Russia
| | - Sergei Zagarov
- Moscow Regional Research and Clinical Institute (“MONIKI”), 129110 Moscow, Russia
| | - Yulia Kovaleva
- Moscow Regional Research and Clinical Institute (“MONIKI”), 129110 Moscow, Russia
| | - Alina Babenko
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia
| | - Yulia Kononova
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia
| | - Elena Kitaeva
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia
| | - Timur Britvin
- Moscow Regional Research and Clinical Institute (“MONIKI”), 129110 Moscow, Russia
| | - Natalia Mazur
- Moscow Regional Research and Clinical Institute (“MONIKI”), 129110 Moscow, Russia
| | - Roman Larkov
- Moscow Regional Research and Clinical Institute (“MONIKI”), 129110 Moscow, Russia
| | - Dmitry Rogatkin
- Moscow Regional Research and Clinical Institute (“MONIKI”), 129110 Moscow, Russia
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Periphere arterielle Verschlusskrankheit bei Diabetes mellitus. Dtsch Med Wochenschr 2022; 147:1433-1437. [DOI: 10.1055/a-1902-6778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Was ist neu?
Morbidität und Mortalität. Patienten mit peripherer arterieller Verschlusskrankheit (pAVK) und Diabetes mellitus stellen eine vulnerable Patientengruppe dar. Sie weisen im Vergleich zu pAVK-Patienten ohne Diabetes eine erhöhte Morbidität und eine gesteigerte Mortalität auf.
Diabetes mellitus – ein relevanter Risikofaktor für Amputationen. Das Vorliegen eines Diabetes mellitus stellt bei Menschen mit einer pAVK ein erhebliches Risiko für eine Amputation dar. Die Inzidenz von Major-Amputationen bei Diabetikern ist nach einer aktuellen Studie 10-mal und von Minor-Amputationen 15-mal höher als bei Nichtdiabetikern. Eine Amputation bei Menschen mit Diabetes mellitus hat zudem einen erheblichen Einfluss auf die Morbidität und Mortalität.
Optimierung der Patientenversorgung notwendig. Trotz großer Anstrengungen im Gesundheitssystem repräsentiert der Diabetes mellitus weiterhin einen bedeutenden Risikofaktor, auch bei Menschen mit pAVK. Unabhängig vom Vorliegen eines Diabetes mellitus wird eine pAVK wiederum bei betroffenen Menschen oftmals nicht erkannt oder nicht adäquat therapiert. Nur wenige Menschen mit pAVK werden gefäßmedizinisch betreut. Zur Reduktion von Morbidität und Mortalität sind Prävention, frühzeitige Detektion sowie eine optimale Therapie von pAVK und Diabetes mellitus allerdings essenziell.
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Schmitt VH, Hobohm L, Vosseler M, Brochhausen C, Münzel T, Espinola‐Klein C, Keller K. Temporal trends in patients with peripheral artery disease influenced by diabetes mellitus in Germany. J Diabetes 2022; 14:670-684. [PMID: 36146952 PMCID: PMC9574718 DOI: 10.1111/1753-0407.13316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/16/2022] [Accepted: 09/06/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION In patients with peripheral artery disease (PAD) the presence of diabetes mellitus (DM) is associated with higher morbidity and mortality. Because huge efforts are made to improve medical care of patients with DM including chronic disease programs, the aim of the present study was to investigate temporal trends regarding the clinical burden of DM on PAD patients within a 15-year observational period. METHODS We analyzed all patients hospitalized because of PAD between 2005 and 2019 in Germany stratified regarding DM. RESULTS Overall, 2 654 871 hospitalizations of PAD patients (865 823 with DM) were included. Hospitalizations based on PAD inclined from 142 778 in 2005 to 190 135 in 2019 (β 3956 per year; 95% confidence interval [CI] 3034-4878, p < .001) with simultaneous increase of hospitalizations of PAD patients with DM (2005: 41609 (29.1%) versus 2019: 65 302 (34.3%); β 2019 per year [95% CI 1593-2446], p < .001). Amputation rates (β -0.42 [95% CI -0.44 to -0.40]; p < .001) as well as in-hospital case-fatality rate (2005: 4.7%, 2019: 2.8%; β -0.64 [95% CI -0.69 to -0.59]; p < .001) decreased in diabetic PAD patients during the observational time. In spite of improved morbidity and mortality in the last years of the observational period, patients with DM still suffered from an increased risk for morbidity and mortality during the observational period compared to nondiabetic PAD patients. CONCLUSIONS Despite the progress in DM treatments, DM still was associated with an unfavorable clinical patient profile and remained a substantial risk factor for morbidity and mortality in hospitalized patients with PAD and DM in Germany between 2005 and 2019.
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Affiliation(s)
- Volker H. Schmitt
- Department of CardiologyUniversity Medical Center Mainz (Johannes Gutenberg‐University Mainz)MainzGermany
- German Center for Cardiovascular sdfsResearch (DZHK)Partner Site Rhine MainMainzGermany
| | - Lukas Hobohm
- Department of CardiologyUniversity Medical Center Mainz (Johannes Gutenberg‐University Mainz)MainzGermany
- Center for Thrombosis and Hemostasis (CTH)University Medical Center Mainz (Johannes Gutenberg‐University Mainz)MainzGermany
| | - Markus Vosseler
- Department of CardiologyUniversity Medical Center Mainz (Johannes Gutenberg‐University Mainz)MainzGermany
| | | | - Thomas Münzel
- Department of CardiologyUniversity Medical Center Mainz (Johannes Gutenberg‐University Mainz)MainzGermany
- German Center for Cardiovascular sdfsResearch (DZHK)Partner Site Rhine MainMainzGermany
| | - Christine Espinola‐Klein
- Department of CardiologyUniversity Medical Center Mainz (Johannes Gutenberg‐University Mainz)MainzGermany
| | - Karsten Keller
- Department of CardiologyUniversity Medical Center Mainz (Johannes Gutenberg‐University Mainz)MainzGermany
- Center for Thrombosis and Hemostasis (CTH)University Medical Center Mainz (Johannes Gutenberg‐University Mainz)MainzGermany
- Medical Clinic VII, Department of Sports MedicineUniversity Hospital HeidelbergHeidelbergGermany
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Behrendt CA, Lareyre F, Raffort J. Impact of Diabetes on Outcomes of Patients With Lower Extremity Artery Disease. Angiology 2022; 73:493-494. [PMID: 35138186 DOI: 10.1177/00033197221074413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Christian-Alexander Behrendt
- Research Group GermanVasc, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Fabien Lareyre
- Department of Vascular Surgery, 70607Hospital of Antibes Juan-les-Pins, France.,439710Université Côte d'Azur, Inserm U1065, C3M, Nice, France
| | - Juliette Raffort
- 439710Université Côte d'Azur, Inserm U1065, C3M, Nice, France.,Clinical Chemistry Laboratory, 37045University Hospital of Nice, France
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Keller K, Schmitt VH, Vosseler M, Brochhausen C, Münzel T, Hobohm L, Espinola-Klein C. Diabetes Mellitus and Its Impact on Patient-Profile and In-Hospital Outcomes in Peripheral Artery Disease. J Clin Med 2021; 10:jcm10215033. [PMID: 34768552 PMCID: PMC8585025 DOI: 10.3390/jcm10215033] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In patients with peripheral artery disease (PAD), the impact of diabetes mellitus (DM) on patient-profile and adverse in-hospital events is not well investigated. METHODS The German nationwide inpatient sample 2005-2019 was used for this analysis. Hospitalized PAD patients were stratified for DM and the influence of DM on patient-profile and adverse in-hospital events was investigated. RESULTS Our study comprised 2,654,871 hospitalizations (54.3% aged ≥70 years, 36.7% females) of patients with PAD in Germany 2005-2019. Among these, 864,691 (32.6%) patients had DM and 76,716 (2.9%) died during hospitalization. Diabetic PAD patients revealed an aggravated cardiovascular profile (Charlson Comorbidity Index: 6.0 (5.0-8.0) vs. 4.0 (3.0-5.0), p < 0.001). PAD patients with DM showed a higher rate of in-hospital mortality (3.5% vs. 2.6%, p < 0.001), as well as major adverse cardiovascular and cerebrovascular events (MACCE, 4.7% vs. 3.3%, p < 0.001) and had more often operated with amputation surgery (16.4% vs. 9.1%, p < 0.001). DM was an independent predictor of in-hospital mortality (OR 1.077 (95%CI 1.060-1.093), p < 0.001) and MACCE (OR 1.118 (95%CI 1.103-1.133), p < 0.001). In addition, amputations were also associated with DM (OR 1.804 (95%CI 1.790-1.818)), p < 0.001). CONCLUSIONS DM is associated with an unfavorable clinical patient-profile and higher risk for adverse events in PAD patients, including substantially increased in-hospital mortality as well as MACCE rate, and were more often associated with amputation surgeries.
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Affiliation(s)
- Karsten Keller
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany; (V.H.S.); (M.V.); (T.M.); (L.H.); (C.E.-K.)
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany
- Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +0049-6131-17-8380; Fax: +0049-6131-17-8461
| | - Volker H. Schmitt
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany; (V.H.S.); (M.V.); (T.M.); (L.H.); (C.E.-K.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, 55131 Mainz, Germany
| | - Markus Vosseler
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany; (V.H.S.); (M.V.); (T.M.); (L.H.); (C.E.-K.)
| | | | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany; (V.H.S.); (M.V.); (T.M.); (L.H.); (C.E.-K.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, 55131 Mainz, Germany
| | - Lukas Hobohm
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany; (V.H.S.); (M.V.); (T.M.); (L.H.); (C.E.-K.)
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany
| | - Christine Espinola-Klein
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany; (V.H.S.); (M.V.); (T.M.); (L.H.); (C.E.-K.)
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