1. Angiographic Features of Atherosclerotic Superficial Femoral Artery Disease in Diabetics and Non-diabetics Presenting with Claudication
Atif Mohammad, MD
Research Fellow
VA North Texas Health Care System
UT Southwestern Medical Center
Dallas,TX
On behalf of the investigators:

2. INVESTIGATORS Atif Mohammad, MD*† Avantika Banerjee* Omar Hadidi, MD†
Gene Pershwitz, MD*
Mirza Baig, MD*†
Emmanouil S. Brilakis, MD, PhD*†
*VA North Texas Health Care System, Dallas, TX; †University of Texas Southwestern Medical Center, Dallas, TX;
Acknowledgements: Dallas VA Research Corporation

3. BACKGROUND & METHOD
Though clinical outcomes following percutaneous revascularization of superficial femoral artery (SFA) varies between diabetics (DM) and non-diabetics, angiographic differences of their SFA disease has never been systemically analyzed
We conducted blinded angiographic analysis of peripheral angiograms in 117 consecutive patients (79 DM and 38 non-DM) between January January 2011, presenting to Veterans Affairs Haelth Care System (Veterans Integrated Service Network or VISN 17) with Rutherford category 3 claudication

4. METHOD: ANGIOGRAPHIC ANALYSIS

5. BOLLINGER SCORE RestenosisΨ Occlusion★ Stenosis >50% < 50%
Plaques
< 25%
Location-Additive Score Points
Change of length 4 2 1
Single 12 13 5 3
Multiple≤ Half segment 14 15 6
Multiple ≥ Half segment 16
Vectorial Score:
★Total occlusions less then half the length of arterial segment will be scored as 13 and more then half as 15.
Ψ13 changes to 14 after change in length and restenosis.15 will change to 16 after restenosis and change in length of the segment. The total additive score is the Bollinger score.

6. RESULTS: Mean Bollinger Scores
p=0.03
Non-DM DM

7. Lesion characteristics
RESULTS:
Lesion characteristics
Non-DM (n=38)
DM (n=79)
All patients (n=117)Ψ p★
Age
64.3±8.9%
64.0±7.6%
64.5±9.3%
0.50
Bilateral SFA lesions
2.7%
23.0%
16.0%
0.01
Ostial SFA
10.8%
0.0%
3.0%
Proximal SFA
51.0%
27.0%
25.0%
0.04
Mid SFA
57.0%
87%
76%
0.09
Distal SFA
69%
50%
0.02
Popliteal
8.0%
18.0%
14.0%
Below the knee
9.0%
7.0%
★DM vs. Non-DM, all lengths and diameters expressed in mm; Ψrepresents all lesions
SFA: superficial femoral artery

8. RESULTS: Angiographic Distribution of SFA in Diabetics & Non-Diabetics
SFA: superficial femoral artery

9. RESULTS: Lesion Flow & Stenosis Characteristics
in Diabetics & Non-Diabetics
Characteristics
Non-DM (n=38)
DM (n=79)
All patients (n=117)Ψ p★
Chronic total occlusion
30.0%
59.0%
49.0%
0.01
Bollinger score
9.0±4.3
12.0±4.8
11.0±5.3
0.03
Calcification
62.0%
87.0%
78.0%
0.09
Grade 1
38.0%
6.0%
16.0%
Grade 2
54.0%
42.0%
45.0%
0.60
Grade 3
8.0%
50.0%
36.0%
Thrombus
25.0%
81.0%
0.02
88.0%
19.0%
41.0%
0.06
11.0%
6.41%
7.7%
2.63%
1.7%
Grade 4
5.0%
Grade 5
33.0%
Mean number of distal run-off vessels
2.5
2.3
2.4
0.04
★DM vs. Non-DM, all lengths and diameters expressed in mm; Ψrepresents all lesions

10. Lesion characteristics
RESULTS: Lesion Characteristics & Revascularization in Diabetics & Non-Diabetics
Lesion characteristics
Non-DM (n=38)
DM (n=79)
All patients (n=117)Ψ p★
Lesion length
143.0±72.0
84.0±51.2
116.0±62.0
0.02
Proximal diameter
3.7±1.1
0.04
Diameter diameter
3.6±1.2
3.1±1.1
3.4±1.8
0.01
Reference diameter
4.0±1.2
4.2±1.4
4.1±1.3
Segment MLD
2.2±0.09
1.5±1.0
1.18±1.0
0.63
Revascularization
All patients (n=117)
Stenting
33.0%
93.0%
63.0%
Debulking
72.0%
10.0%
41.0%
0.008
Stent length
195.0±116.0
241.5±98.0
218.0±107.0
3±1.4
3.1±1.4
0.40
Distal diameter
3±1.3
3.5±1.4
3.3±1.37
0.17
Stent mean luminal diameter
1.8±0.5
2±0.9
1.9±0.5
0.20
★DM vs. Non-DM, all lengths and diameters expressed in mm; Ψrepresents all lesions; MLD: minimal luminal diameter

11. Lesion characteristics
RESULTS: Procedural Complications & Outcomes in Diabetics & Non-Diabetics
Lesion characteristics
Non-DM (n=38)
DM (n=79)
All patients (n=117)Ψ p★
Bend
13.0%
11.5%
12.0%
0.82
Eccentric lesions
8.0%
10.0%
0.70
Distal embolization
0.0%
1.00
Dissection
3.0%
0.20
Dissection length
0.0
9.1±4.0
50%
0.02
Abrupt Closure
6.0%
0.60
In segment % stenosis
34.0%
33.0%
0.80
In stent % stenosis
30.0%
Patency at 6 month
100.0%
80.0%
87.0%
0.14
Patency at 12 months
63.0%
70.0%
0.004
★DM vs. Non-DM, all lengths and diameters expressed in mm; Ψrepresents all lesions

12. CONCLUSIONS:
These results indicate the greater severity of SFA disease in patients with diabetes mellitus, increased need for stenting & lower 12 month patency
Our findings also indicate to the need for dedicated strategies for improving outcomes in diabetics with peripheral arterial disease undergoing endovascular revascularization procedures for life- style limiting claudication
SFA: superficial femoral artery