Diabetes and the outcome of infrainguinal bypass for critical limb ischaemia

Area of Science:

• Vascular Surgery
• Diabetology
• Ischaemic Limb Disease

Background:

• Diabetes mellitus (DM) is a significant comorbidity affecting vascular health.
• Critical foot ischaemia poses a major challenge in diabetic patients, often requiring complex surgical interventions like infrainguinal bypass.
• Understanding the specific impact of DM on surgical outcomes is crucial for optimizing patient care.

Purpose of the Study:

• To investigate the influence of diabetes mellitus (DM) on the outcomes of infrainguinal bypass operations.
• To compare the results of infrainguinal bypass surgery in diabetic versus non-diabetic Chinese patients presenting with critical foot ischaemia.

Main Methods:

• A prospective audit was conducted on 265 consecutive infrainguinal bypass operations.
• Patient data, including comorbidities, presentation, surgical details, and outcomes, were systematically collected and analyzed.

Main Results:

• Diabetic patients presented with higher rates of ischaemic heart disease and tissue loss.
• While early outcomes like graft failure and wound infection were comparable, diabetic patients experienced higher hospital mortality and required more frequent surgical debridement.
• Long-term patient survival was significantly lower in the diabetic group, although graft patency and limb salvage rates were similar between groups.

Conclusions:

• Diabetes mellitus is associated with increased hospital mortality and reduced long-term survival following infrainguinal bypass for critical foot ischaemia.
• Despite these adverse effects on survival, the presence of DM does not appear to compromise the technical success of the bypass graft in terms of patency or the ability to salvage the limb.