Resultados de la revascularización de extremidades inferiores para la isquemia crónica amenazante de miembro en...

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.