Perioperative complications after revascularization in diabetic and nondiabetic chronic limb-threatening ischemia patients and its relation with preoperative hemoglobin A1c

• Main Authors: S Roshan Rodney, Vivekanand, M Vishnu, K B Sumanthraj, Hemant Chaudhari, Dharmesh Davra, Piyushkumar Jain, C P S Sravan, Vaibhav Lende, Hudgi Vishal, K Sivakrishna, B Nishan
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Indian Journal of Vascular and Endovascular Surgery
• Subjects: endovascular; ischemia; mortality; perioperative; revascularization
• Online Access: http://www.indjvascsurg.org/article.asp?issn=0972-0820;year=2020;volume=7;issue=1;spage=54;epage=57;aulast=

Background: Hemoglobin A1c (HbA1c) reflects average blood glucose over a 2–3 month period. Patients with an elevated HbA1c with and without diabetes have an increased risk of adverse outcomes following surgical intervention. Our aim is to determine whether elevated plasma HbA1c level is associated with high perioperative morbidity and mortality in chronic limb-threatening ischemia (CLTI) patients undergoing peripheral revascularization. Materials and Methods: This is a single center, retrospective analysis of 307 CLTI patients who underwent lower limb revascularization (open/endovascular/hybrid) at Jain Institute of Vascular Sciences over a 1-year period from January 2018 to December 2018. Patients were categorized into two groups as either diabetic or nondiabetic based on their history and preoperative plasma HbA1c level ≥6.5% or <6.5%, respectively. Diabetics were stratified into four subgroups (HbA1c ≥6.5%–7.4%, HbA1c 7.4%–8.9%, and HbA1c ≥9%) and controlled diabetes mellitus (HbA1c <6.5%) and nondiabetics into two subgroups (HbA1c <6.0 and HbA1c ≥6%–6.5%. The primary endpoints include perioperative major adverse cardiac event (MACE), major adverse limb event (MALE), and mortality. Results: Of 307 patients, 253 (82.4%) were diabetics and the rest 54 (17.6%) were nondiabetics. On comparison with other HbA1C groups, among diabetics those with HbA1c >9% had a significantly higher incidence of perioperative MACE 7 (12.07%), MALE 3 (5.17%), and death 6 (10.34%), and among nondiabetics, those with HbA1c levels (6%–6.5%) had a higher incidence of perioperative MACE 3 (9.68%), MALE 1 (3.23%), and death 1 (3.23%), but the difference was not statistically significant. Conclusion: HbA1c levels serve as an independent predictor of untoward events in CLTI patients with or without diabetes undergoing revascularization.