Does diabetes mellitus play a role in restenosis and patency rates following lower extremity peripheral arterial revascularization? A critical overview

Patients with diabetes mellitus (DM) are at increased risk of developing lower extremity peripheral arterial disease (PAD). The effect of DM on restenosis and patency rates in patients with PAD undergoing surgical revascularization or percutaneous interventions has not been fully clarified. We therefore critically reviewed the role of DM in restenosis, as well as primary and secondary patency rates in these patients. We searched Medline for studies investigating the effect of DM on restenosis (primary and secondary patency) rates in patients undergoing surgical/percutaneous interventions for the treatment of lower extremity PAD. Search terms used were "diabetes and peripheral arterial disease," "angioplasty," "restenosis," "revascularization," "patency rates," and "in-stent restenosis." Diabetic patients with PAD have similar restenosis, primary patency, and secondary patency rates compared with nondiabetic patients. However, mortality and amputation rates are increased in patients with DM. This increased risk of mortality and amputation may distort the estimation of restenosis and patency rates. Strict glucose control should be implemented in diabetic patients. Additionally, the use of antiplatelet agents and statins may have a beneficial effect on restenosis and patency rates. The role of radiation therapy in preventing restenosis remains to be determined. Patients with PAD and DM should receive optimal medical therapy to improve cardiovascular outcome and decrease functional decline. The direct involvement of vascular surgeons in the management of PAD patients is essential to reduce the incidence of cardiovascular events and mortality rates.