Endovascular approach to Diabetic Limb Ischemia tied to Lowe
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In diabetic patients with critical limb ischemia (CLI), endovascular revascularization was associated with lower in-hospital mortality but more major amputations than surgical revascularization in database analysis.

The purpose of this study by JACC: Cardiovascular Interventions was to evaluate temporal trends in the frequency of revascularization and associated outcomes in patients with diabetes mellitus and critical limb ischemia (CLI).

Temporal trends in hospitalization for CLI among patients with diabetes were determined using the 2002–2015 National Inpatient Sample database. Propensity score matching was used to compare patients who underwent revascularization with those who did not and, separately, to compare those who underwent endovascular versus surgical revascularization. The main study outcome was in-hospital mortality.

The analysis included 1222324 hospitalizations. There was an increase in the use of lower extremity revascularization, paralleled by a decline in in-hospital mortality during the study period.

--In the matched cohort, patients who were revascularized had lower in-hospital mortality and major amputation compared with those who were treated medically.

--Compared with endovascular revascularization, those who underwent surgical revascularization had higher rates of in-hospital mortality but lower rates of major amputation.

--Major bleeding, blood transfusion, post-operative infection, respiratory complications, discharges to the nursing facility, and longer length of hospital stay were also more common among those who underwent surgery.

In particular, although in-hospital mortality decreased over time regardless of the treatment strategy used, this outcome occurred less frequently among those who underwent revascularization than not. Compared with surgical revascularization, endovascular revascularization was associated with lower in-hospital mortality but higher rates of major amputation.

Source: https://doi.org/10.1016/j.jcin.2020.11.032
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