| Abstract [eng] |
Object of the research. 27–90 years old patients having the type 1 and type 2 diabetes mellitus and peripheral artery disease, who were treated at the Vilnius University Vascular Surgery Center in the Vilnius town University Hospital in the year 1997–2011. The aim of our research was. To analyse aspects of peripheral artery disease in patients with diabetes mellitus, who were cured at Vilnius University Vascular Surgery Center in the Vilnius town University Hospital as well as to determine the consequenses of PAD and the risk factors PAD. Material and methods of the research. 925 cases of the type 1 and type 2 diabetes mellitus were explored at the Vilnius University Vascular Surgery center in the Vilnius town University hospital in the year 1997–2011, who received treatment for the peripheral artery disease. The statistic survey has been done using the program pack SPSS 19.0 for Windows. Statistic importance level α=0.05. Results. Data about 378 women and 538 men have been explored. An average age of all the patients was 67.99±9.47 years. 95.6% of patients had the type 2 diabetes mellitus. An average duration of having disease was 12.95±9.91 years, 47.8% of cases had diabetic angiopathy, 34.9% of patients had nephropaty, 14.6% of cases had retinopathy, 33.7% of all the cases had polyneuropathy. According to the statistic importance rates retinopathy, nephropathy, polyneuropathy are more often among patients with the type 1 diabetes mellitus. Cardiovascular diseases were the most common disease among the patients. 21.2% of all cases that have been checked have already had an amputation. An average duration of the hospitalisation was 17.3±10.80 days. 369 patients underwent amputations: 197 cases (21.3%) fingers amputations, 32 cases (3.5%) distal part of the foot, 10 cases (1.1%) amputation of the foot above ankle, 66 cases (7.1%) of the amputation of shin, 64 cases (6.9%) of the amputation of thigh. There have been 360 (39%) patients who underwent bypass surgery and 155 (17%) who had angioplasty (PTA). Patients after amputations have been hospitalised for 18.35±10.39 days, and it is statisticaly 2.35 days longer than those after bypass surgery (p=0.012) and 8.9 days longer than those after PTA (p<0.0001). Analysing the relation between PAD sympthoms and the duration of the hospitalization has shown that the patients who did not have any leg‘s pain were cured 1.67 days longer, than those who felt pain (p=0.014). Patients with the gangrene of fingers were cured 2.29 days longer than those with healthy fingers (p=0.007), and those with the gangrene of the foot were hospitalised 1.97 days longer than those with the healthy feet (p=0.048). Conclusions: 1. Male, age more than 60 years, type 2 diabetes mellitus, the duration of having the disease more than 10 years and multiple complications may result in PAD. Chronic critical limb ischaemia was found in 83.5% of all patients with diabetes and PAD. Pregangrene was found more often in type 2 diabetes patients. More than one third of all the patients with the disease have foot intergrity damage without any pain. 2. Amputations were performed in 39.9% of the patients, for one third of them major amputations were done. Patients after amputations lying in the hospital for 2.35 days longer than those who underwent bypass surgery, and 8.29 days longer than those after PTA. Type 2 diabetes patients 1.6 times more often underwent bypass surgery. For women 1.3 times more often PTA was done. 3. Previous amputation and bypass surgery are an independent risk factors for limb amputation in diabetes patients. Previous amputation increase the abbility for subsequent amputations 3.15 times, and bypass surgery performed in the past increase futher amputation rate for 1,87 times. The complications of the diabetes – polyneuropathy and angiopathy reduces possibility and odds for patients-friendly bypass surgery or angioplasty. |
