Outcomes of lower extremity revascularization for chronic limb-threatening ischemia in diabetic and non-diabetic...

Peripheral arterial disease is characterized by impaired perfusion to the lower limbs, primarily due to atherosclerosis. This study aimed to evaluate and compare the short - and long-term outcomes of femoropopliteal bypass revascularization using autologous veins in diabetic and non-diabetic patients with chronic limb-threatening ischemia (CLTI).

A single-center, retrospective, comparative study was conducted over a 10-year period (1 July 2013 to 1 July 2023), involving 300 patients (150 diabetics, 150 non-diabetics), all diagnosed with CLTI. All patients underwent femoropopliteal bypass using primarily autologous great saphenous vein (GSV) conduits. Clinical presentation, perioperative outcomes, ankle-brachial index (ABI), and quality of life (VASCUQoL-6) scores were assessed at regular intervals over a 36-month follow-up.

Both groups had similarly poor preoperative ABI scores (mean 0.3 in diabetics, 0.33 in non-diabetics). At 12 months, ABI outcomes were comparable across both groups, with no significant difference in distribution. Diabetic patients had higher re-intervention (29.3%) and major amputation rates (12.7%) compared to non-diabetics (18.7% and 7.3%, respectively), but also achieved a slightly higher limb salvage rate (69.3% vs 66.7%). VASCUQoL-6 scores improved significantly in both groups, with average scores rising from 4 to 5 preoperatively to ≥20 by 36 months. Mortality and complication rates, including surgical site infections, were similar.

Femoropopliteal bypass using autologous vein grafts offers effective long-term outcomes for diabetic and non-diabetic CLTI patients. While diabetic patients faced higher risks of re-intervention and amputation, limb salvage and quality-of-life improvements were comparable. Open surgery remains a valuable revascularization option in selected CLTI patients.