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[In situ bypass and diabetes]
L P Jensen1, T V Schroeder, J E Lorentzen
1Rigshospitalet, karkirurgisk afdeling RK., København.
Insights
The in situ bypass technique is effective for critical limb ischemia in diabetic patients. While minor amputation rates were higher in diabetics, overall outcomes were comparable to non-diabetic patients.
Area of Science:
- Vascular Surgery
- Diabetic Complications
- Lower Limb Ischemia
Context:
- The study evaluated the efficacy of in situ bypass procedures for critical limb ischemia.
- A cohort of 444 patients, including diabetic and non-diabetic individuals, underwent 483 procedures between 1986 and 1990.
- Diabetic patients presented with more critical limb ischemia and lower distal anastomoses.
Purpose:
- To assess the outcomes of in situ bypass surgery in diabetic versus non-diabetic patients with critical limb ischemia.
- To compare patency rates, amputation rates, and survival between the two groups.
Summary:
- Preoperative risk factors were similar, except for higher smoking rates and cardiac disease in diabetics.
- Three-year primary and secondary patency rates were comparable (58% and 64%).
- Diabetic patients experienced higher minor amputation rates, but major amputation rates were similar. Survival rates were lower in diabetics.
Impact:
- The in situ bypass technique demonstrates significant utility in treating critical lower limb ischemia in diabetic patients.
- Despite increased minor amputation risk, diabetic patients achieve comparable limb salvage and patency rates to non-diabetic patients.
- Findings support the use of in situ bypass for diabetic patients with critical limb ischemia, highlighting the need for careful management of amputation risk.
Abstract:
From 1986 through to 1990 a total of 483 in situ bypass procedures were performed in 444 patients. Preoperative risk-factors were equally distributed among diabetic (DM) and non-diabetic (NDM) patients, except for smoking habits (DM:48%, NDM:64%, p = 0.002) and cardiac disease (DM:45%, NDM:29%, p = 0.005). Critical limb-ischaemia was more often present in diabetic than non-diabetic patients (DM:57%, NDM:36%, p = 0.0002). Diabetic patients had a significantly lower distal anastomosis than non-diabetic patients (p = 0.00001). There were no differences among diabetic and non-diabetic patients regarding three years primary and secondary patency (58% and 64% respectively), and regarding major amputations. However, the rate of minor amputations was higher in insulin-dependent compared with non-insulin-dependent diabetics, who in turn had a higher rate than non-diabetics (p < 0.00001). A markedly decreased survival rate was found in diabetics (p < 0.00005). We found the in situ bypass technique very useful in the treatment of critical ischaemia of the lower limb in diabetic patients. The overall results in diabetic patients, whether insulin-dependent or not, were equal to those in non-diabetic patients.