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Glycemic Variability as a Predictor of Graft Failure Following Infrainguinal Bypass for Peripheral Arterial Disease:

Daniel J Farndon1, Philip C Bennett2, Ian Nunney3

  • 1Norfolk and Norwich Vascular Unit, Norfolk & Norwich University Hospital, Norwich, UK; Norwich Medical School, University of East Anglia, Norwich, UK.

Annals of Vascular Surgery
|April 8, 2024
PubMed

Insights

High glycemic variability (GV) is linked to lower graft patency after infrainguinal bypass (IIB). Optimizing GV may improve outcomes for patients undergoing this procedure.

Area of Science:

  • Vascular Surgery
  • Endocrinology
  • Metabolic Health

Background:

  • Glycemic variability (GV) is associated with adverse outcomes.
  • The effect of GV on infrainguinal bypass (IIB) graft patency is not well understood.

Purpose of the Study:

  • To investigate the impact of GV on graft patency following IIB.
  • To determine if GV is an independent predictor of IIB outcomes.

Main Methods:

  • Retrospective analysis of 106 IIB cases between 2017-2019.
  • Assessment of GV (visit-to-visit HbA1c change), bypass details, and patient demographics.
  • Primary patency (PP) was defined by time to reintervention, amputation, or death.

Main Results:

  • GV > 9.1% was associated with significantly lower median PP (198 days) compared to GV < 9.1% (713 days).
  • GV > 9.1% was an independent predictor of lower PP (HR 1.96).
  • Bypass level, particularly below-knee and tibial, also independently predicted lower PP.

Conclusions:

  • Glycemic variability is an independent predictor of primary patency after infrainguinal bypass.
  • Optimizing glycemic variability should be a therapeutic target to improve IIB outcomes.
Abstract

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