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Comparative analysis of patency, limb salvage and survival in diabetic and non-diabetic patients undergoing
S Karacagil1, B Almgren, S Bowald
1Department of Surgery, University Hospital, Uppsala, Sweden.
Insights
Diabetic patients undergoing femoropopliteal bypass have similar graft patency and limb salvage rates compared to non-diabetics. However, diabetic patients face significantly lower survival rates, particularly those with poor distal runoff.
Area of Science:
- Vascular Surgery
- Diabetic Complications
- Bypass Grafting
Background:
- Diabetes mellitus is a significant risk factor for peripheral arterial disease.
- Femoropopliteal and femorodistal bypass procedures are critical for limb salvage in these patients.
- Outcomes in diabetic versus non-diabetic patients undergoing these procedures require detailed analysis.
Purpose of the Study:
- To comparatively analyze the 1- and 3-year cumulative patency, limb salvage, and survival rates.
- To assess the impact of diabetes on outcomes following femoropopliteal or femorodistal bypass.
- To investigate the influence of distal runoff on outcomes in diabetic patients.
Main Methods:
- Life-table analysis of 336 femoropopliteal/femorodistal bypass procedures.
- Comparative analysis of outcomes in 92 diabetic and 175 non-diabetic patients.
- Stratification of results based on distal limb runoff (good vs. poor).
Main Results:
- Peroperative mortality was higher in diabetic patients (5% vs. 1.4%).
- 1- and 3-year graft patency rates were similar between diabetic (61%, 46%) and non-diabetic (64%, 52%) patients.
- 3-year limb salvage rates were comparable (70% diabetic vs. 62% non-diabetic).
- 3-year survival rates were significantly lower in diabetic patients (62% vs. 86%).
- Diabetic patients with poor runoff had substantially lower 3-year survival (48%) compared to those with good runoff (74%).
Conclusions:
- Early and intermediate graft patency and limb salvage rates are comparable between diabetic and non-diabetic patients.
- Diabetic patients exhibit significantly lower long-term survival rates after bypass surgery.
- Poor distal runoff is a critical factor associated with reduced survival in diabetic patients undergoing bypass procedures.
Abstract:
In 92 diabetic and 175 non-diabetic patients undergoing 336 femoropopliteal or femorodistal bypass procedures, 1- and 3-year cumulative life-table patency, limb salvage, and survival rates were comparatively analysed. The peroperative mortality rate was significantly higher in diabetic patients (5% compared to 1.4%, p < 0.001). The cumulative graft patency rates were 61% at 12 months and 46% at 36 months in diabetic patients compared to 64 and 52% in non-diabetic patients. Significantly better patency rates were observed in limbs with good runoff compared to limbs with poor runoff in both groups. The limb salvage rates at 3 years were 70% in diabetic patients and 62% in non-diabetic patients. The survival rate at 3 years was significantly lower in diabetic patients, 62% compared to 86% in non-diabetic patients. Diabetic patients with poor runoff demonstrated a significantly lower survival rate after 36 months compared to diabetic patients with good runoff (48% and 74%, respectively). The results of this study demonstrate that the early and intermediate patency and limb salvage rates are similar in diabetic and non-diabetic patients. On the other hand the survival rate in diabetic patients, especially in those with poor distal runoff, is significantly lower than non-diabetic patients.
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