Annals of vascular surgery · 2026
Sodium Glucose Cotransporter-2 Inhibitors are Not Associated with Amputation After Lower Extremity Revascularization in Patients with Diabetes.
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Alappan Uma D, Chetty Ashwin K, Carter Warren, Wells Nicholas, Alameddine Dana, Inzucchi Silvio E, Guzman Raul, Ochoa Chaar Cassius Iyad
Аннотация
BACKGROUND: Diabetes mellitus (DM) is a significant risk factor for peripheral arterial disease (PAD) and can lead to chronic limb-threatening ischemia requiring revascularization. Though Sodium Glucose Cotransporter-2 inhibitors (SGLT2i) have cardiorenal benefits, there is concern for increased amputation-risk in patients with PAD. This study assesses SGLT2i use in patients with DM undergoing lower extremity revascularization (LER) for PAD and associated outcomes.
METHODS: A retrospective cohort review of patients undergoing LER for PAD (2013-2020) in a tertiary care center was performed. Open and endovascular LERs were included. Patients undergoing initial revascularization for acute limb ischemia or with SGLT2i contraindication were excluded (chronic kidney disease stage 4/5/dialysis). Characteristics/outcomes of patients on versus not on SGLT2i at index revascularization were compared using propensity 3:1-matching and Kaplan-Meier (KM) curves for long-term outcomes. R software was used for analysis.
RESULTS: Two thousand thirty-nine patients underwent LER for PAD and 1147 (56.3%) had DM. SGLT2i use increased from 0% to 10.3% (2013-2020; P < 0.001). Differences in demographics, comorbidities, and procedural type (endovascular/open/hybrid) were significant prior to matching but not after. Fifty-six point four percent of patients used insulin preoperatively with no difference in preoperative and postoperative hemoglobin A1C between the groups. Patients on SGLT2i had higher perioperative return to operating room (24.6% v 10.8%; P = 0.006) but shorter length of hospital stay (4.5 vs. 7.0; P = 0.046) compared to patients not on SGLT2i. There was no difference in perioperative major or minor amputation or KM analysis of major amputation, all-cause-mortality, or MALE-free-survival between the groups.
CONCLUSION: SGTL2i use has increased in patients with DM undergoing LER and was not associated with increased amputation after LER.
METHODS: A retrospective cohort review of patients undergoing LER for PAD (2013-2020) in a tertiary care center was performed. Open and endovascular LERs were included. Patients undergoing initial revascularization for acute limb ischemia or with SGLT2i contraindication were excluded (chronic kidney disease stage 4/5/dialysis). Characteristics/outcomes of patients on versus not on SGLT2i at index revascularization were compared using propensity 3:1-matching and Kaplan-Meier (KM) curves for long-term outcomes. R software was used for analysis.
RESULTS: Two thousand thirty-nine patients underwent LER for PAD and 1147 (56.3%) had DM. SGLT2i use increased from 0% to 10.3% (2013-2020; P < 0.001). Differences in demographics, comorbidities, and procedural type (endovascular/open/hybrid) were significant prior to matching but not after. Fifty-six point four percent of patients used insulin preoperatively with no difference in preoperative and postoperative hemoglobin A1C between the groups. Patients on SGLT2i had higher perioperative return to operating room (24.6% v 10.8%; P = 0.006) but shorter length of hospital stay (4.5 vs. 7.0; P = 0.046) compared to patients not on SGLT2i. There was no difference in perioperative major or minor amputation or KM analysis of major amputation, all-cause-mortality, or MALE-free-survival between the groups.
CONCLUSION: SGTL2i use has increased in patients with DM undergoing LER and was not associated with increased amputation after LER.
Предметные рубрики MeSH
HumansAmputation, SurgicalRetrospective StudiesFemaleMaleSodium-Glucose Transporter 2 InhibitorsPeripheral Arterial DiseaseTreatment OutcomeTime FactorsAgedRisk FactorsLower ExtremityRisk AssessmentMiddle AgedVascular Surgical ProceduresLimb SalvageIschemiaAged, 80 and overEndovascular ProceduresDiabetes Mellitus