Current assessment of endovascular therapy for infrainguinal arterial occlusive disease in patients with diabetes

Endovascular therapy (EVT) has increasingly become the initial clinical option for treatment of lower extremity peripheral arterial disease (PAD), not only for patients with claudication, but also for those with critical limb ischemia. Despite this major clinical practice paradigm shift, the outcomes of EVT for PAD are difficult to evaluate and compare with established surgical benchmarks because of the lack of prospective, randomized trials, incomplete characterization of indications for intervention, mixing of arterial segments and extent of disease treated, the multiplicity of EVT techniques used, the exclusion of early treatment failures, crossover to open bypass during follow-up, and the frequent lack of intermediate and long-term patency and limb salvage rates in life-table format. These data limitations are especially problematic when one tries to assess the outcome of EVT in patients with diabetes. The purpose of the present report is to succinctly review and objectively analyze available data regarding the results of EVT in patients with diabetes.