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390 Role of Percutaneous Intervention in
Cardiovascular Diseases in Diabetes

ful in guiding the appropriate treatment modalities in diseases of the aorta, carotid artery disease, subcla-
diabetics with foot lesion. vian artery disease, etc can also be treated percuta-
neously whenever required.
(iii) Similarly, from time to time renal angiogram helps
to diagnose renal artery stenosis as the cause of re-
sistant hypertension and recurrent cardiac failure due (d) Venous interventions in chronic kidney
to accelerated hypertension. disease
(CKD) patients undergoing dialysis is yet another
6. Role of percutaneous intervention in the manage-
ment of Cardiovascular diseases in diabetics: area where percutaneous therapies play a role in
preventing arterio-venous fistula failures and treating
Percutaneous intervention is very useful in several central venous occlusions.
clinical situations in the management of cardiovas-
cular diseases in diabetics. They include: 7. Thus percutaneous intervention plays a signifi-
cant role in the management of various forms of
(a) Coronary artery disease: cardio-vascular diseases in the diabetes. The lecture
would illustrate the benefits of percutaneous inter-
Coronary artery disease is perhaps the single largest vention based on our experience over the past 5
contributor to the morbidity and mortality amongst years and stress the need for more awareness about
cardio-vascular diseases in diabetics. Primary angio- this specialised area of Diabetes Care
plasty for acute myocardial infarction in general and
in diabetics in particular has shown significant mor- and its greater application in clinical practice.
tality benefit, preservation of left ventricular
Summary
function and shortening of hospital stay in all the
major land mark trials. The same is true for other * Macrovascular disease is the leading causes of
forms of acute coronary syndromes. The debate be- morbidity and mortality in diabetes.
tween multi-vessel percutenous transluminal coro- * Coronary artery disease, peripheral arterial disease
nary angioplasty (PTCA) and coronary artery bypass and arterio-venous fistula failure contribute signifi-
graft (CABG) for stable angina is going on for more cantly to the burden in diabetics.
than a decade. However, with the availability of third
generation drug-eluting stents there is now data to * Apart from medical line of management, only sur-
show that multi-vessel PTCA in diabetics is non-in- gical management of these conditions was hitherto
ferior to CABG. This assumes greater significance in available.
our country today after the standardization of the * Now, percutaneous intervention in atherosclerotic
cost of stents. disease of the coronaries, peripheral arteries and oth-
er macrovessels with high success rates has opened
(b) Peripheral arterial disease: up new vistas in their management.
Next to coronary artery disease, atherosclerotic pe- * More awareness and greater application in clinical
ripheral arterial disease contributes significantly to practice of percutaneous intervention as a special-
the morbidity and mortality in diabetics. Indeed it is ised area of Diabetes Care needs to be stressed.
largely under - diagnosed and undertreated com-
pared to atherosclerotic coronary artery disease.
Atherosclerotic diseases of lower limb arteries from
iliac to tibial arteries can be successfully treated per-
cutaneously to heal ischaemic ulcers and save limbs
threatened by

acute limb ischaemia can also be salvaged by percu-
taneous means. Lower limb interventions pose par-
ticular challenge to interventionists due to difficulty
in hardware selection and complexity of the anatomy
of the lesion.

(c)Renal artery disease

GCDC 2017