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'Diabetic tibial disease': the case for revascularisation

B M Stephenson1, A A Shandall, K Shute

  • 1Department of Surgery, Royal Gwent Hospital, Newport.

Annals of the Royal College of Surgeons of England
|March 1, 1993
PubMed

Insights

Diabetic patients with critical limb ischemia can often avoid amputation. Short vein bypasses successfully revascularized limbs in a small study, preserving lower limb function and preventing major amputation.

Area of Science:

  • Vascular Surgery
  • Diabetic Limb Complications

Background:

  • Diabetic patients with critical lower limb ischemia are often deemed unreconstructable.
  • Palpable popliteal pulse in diabetics is frequently mislabeled as 'small vessel disease'.

Purpose of the Study:

  • To evaluate the efficacy of short vein bypasses in limb salvage for diabetic patients with critical tibial disease.
  • To emphasize the importance of thorough vascular assessment before amputation.

Main Methods:

  • Retrospective analysis of nine diabetic patients (mean age 69) with critical limb ischemia.
  • Utilized short vein bypasses for revascularization.
  • Assessed patency rates and limb salvage outcomes.

Main Results:

  • Major amputation was avoided in all nine patients.
  • All revascularizations remained patent at a mean follow-up of 32 months (range 12-60 months).

Conclusions:

  • Short vein bypasses are a viable option for limb salvage in select diabetic patients with critical tibial disease.
  • Arteriography is crucial to assess distal revascularization potential before amputation.
  • Doppler insonation of tibial and pedal vessels should be considered if arteriography is inconclusive.

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