Distal arterial reconstruction: patency and limb salvage in diabetics

Controversy regarding efficacy and durability of distal bypass grafting of the diabetic patient exists. A 22-year-long series of 259 vascular procedures with 100% follow-up (57% in diabetic individuals) is examined to compare these results with those of non-diabetic patients. Extensive review of predisposing factors, operative indications, preoperative medical evaluation, as well as techniques and peculiarities of angiography is rendered. Peripheral arterial case mix between the two groups is examined. The high utilization rate of solely venous conduits (94%) in diabetics compared with 76% in nondiabetics, along with anastomosis site selection, provides the most reasonable explanation for the successful outcome in both groups. Modifications in revascularization techniques contributing to successful outcome are presented. In the diabetic patients, both the cumulative graft patency rate (63%) and the limb salvage rate (77%) at 6 years were superior to those of the non-diabetics (52% and 65%, respectively). Diabetes mellitus does not predispose the person requiring revascularization for limb salvage to a lesser likelihood of success.