Lesion Morphology and Technical Success in Diabetic vs. Non-Diabetic Patients with Chronic Limb-Threatening Ischemia Undergoing Endovascular Treatment: A Retrospective Single-Center Study.

摘要

Background and Objectives: Chronic limb-threatening ischemia (CLTI) represents the most advanced stage of peripheral arterial disease and is associated with an increased risk of major amputation, particularly in patients with diabetes, in whom arterial disease frequently presents with distinct anatomical patterns. While global scores are widely used, the impact of lesion morphology on procedural outcomes is less clearly defined. This study aims to evaluate the distribution of lesion types (stenoses versus occlusions) and their association with the technical success of endovascular revascularization in CLTI, with a focus on differences between diabetic and non-diabetic patients. Materials and Methods: This retrospective study included 136 consecutive patients with chronic limb-threatening ischemia (CLTI) who underwent endovascular revascularization at the Vascular Surgery Department of the "Sf. Spiridon" Clinical Emergency Hospital, Iași, Romania, between May 2021 and May 2023, comprising 85 (62.5%) diabetic and 51 (37.5%) non-diabetic patients. The mean age of the study population was 69.9 ± 9.7 years, and 38 (27.9%) patients were female. Baseline demographic characteristics and major comorbidities were broadly comparable between the two groups. Angiographic lesions were classified according to the degree of luminal narrowing as non-significant stenosis (<50%), significant stenosis (≥50%), or occlusion (complete absence of contrast flow) at the femoropopliteal and infrapopliteal levels. Technical success was defined as restoration of "inline" flow to the leg with residual stenosis < 30%. Patients treated with stenting and those undergoing infrapopliteal angioplasty received short-term (up to 6 weeks) dual antiplatelet therapy. Associations between lesion morphology and procedural outcomes were assessed using appropriate statistical methods. Results: Diabetic patients had more frequent stenotic lesions (55.3% vs. 35.3%, p = 0.024) at the infrapopliteal level, whereas non-diabetic patients had more frequent occlusive lesions (96.1% vs. 83.5%, p = 0.028) at the femoropopliteal level. These differences were associated with procedural outcomes. Occlusive lesions, especially at key anatomical segments, were associated with an increased risk of technical failure, whereas stenotic lesions were more frequently associated with successful endovascular revascularization. Conclusions: Morphological characteristics of lesions play a critical role in determining the success of procedures in CLTI. Stenotic lesions in diabetic patients suggest a distinct vascular phenotype that may influence revascularization strategies. The results highlight the importance of detailed lesion assessment in planning interventions, beyond the use of conventional scores.