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Lower extremity revascularization in diabetes: late observations
C M Akbari1, F B Pomposelli, G W Gibbons
1Department of Surgery, Beth Israel, Deaconess Medical Center, Harvard Medical School, Boston, Mass, USA. cakbari@caregroup.harvard.edu
Archives of Surgery (Chicago, Ill. : 1960)
|April 18, 2000
Summary
Diabetic patients undergoing infrainguinal arterial bypass show similar graft patency, limb salvage, and survival rates compared to non-diabetic patients. Aggressive limb salvage is warranted for diabetic individuals, as concerns about poor long-term outcomes are unfounded.
Area of Science:
- Vascular Surgery
- Diabetic Complications
- Limb Salvage Procedures
Background:
- Infrainguinal arterial bypass is crucial for diabetic limb and foot salvage.
- However, concerns exist regarding high late mortality and limb loss in diabetic patients.
Purpose of the Study:
- To evaluate the long-term outcomes of infrainguinal arterial bypass in diabetic versus non-diabetic patients.
- To determine if diabetes mellitus negatively impacts graft patency, limb salvage, and survival rates.
Main Methods:
- An inception cohort of 843 patients undergoing infrainguinal arterial bypass with vein grafts was followed for a minimum of 5 years.
- Patients were divided into diabetic (DM) and non-diabetic (NDM) groups.
- Outcomes assessed included graft patency, limb salvage, and survival.
Main Results:
- Five-year primary and secondary graft patencies were 74.7% and 76.2%, respectively, with no significant difference between DM and NDM groups.
- The 5-year limb salvage rate was 87.1%, also unaffected by diabetes.
- Five-year survival was 58.1% overall, with virtually identical rates in both groups.
Conclusions:
- Diabetes mellitus does not adversely affect late mortality, graft patency, or limb salvage rates after infrainguinal arterial reconstruction.
- Aggressive limb salvage interventions in diabetic patients are justified, as long-term outcomes are comparable to non-diabetic patients.