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Lower Extremity Revascularization in Diabetes
Late Observations
Cameron M. Akbari, MD;
Frank B. Pomposelli, Jr, MD;
Gary W. Gibbons, MD;
David R. Campbell, MD;
Michele C. Pulling, BA;
Darius Mydlarz, BA;
Frank W. LoGerfo, MD
Arch Surg. 2000;135:452-456.
Hypothesis Despite the success of infrainguinal arterial bypass in diabetic limb and foot salvage, optimism remains guarded because of purported high late mortality and limb loss in patients with diabetes.
Design Inception cohort, with minimum 5-year follow-up.
Setting Tertiary referral center.
Patients Eight hundred forty-three consecutive patients undergoing lower extremity arterial reconstruction from July 1, 1990, through July 31, 1993.
Intervention Infrainguinal arterial bypass with vein graft.
Main Outcome Measures Graft patency, limb salvage, and survival.
Results A total of 962 vein grafts (843 patients) were performed; 795 grafts (82.6%) were performed in patients with diabetes (DM group) and 167 (17.4%) in nondiabetic patients (NDM group). Average age was 68.4 years, and was lower in the DM group (66.2 [range, 27-92 years] vs 70.5 years [range, 37-96 years]) (P=.005). In-hospital 30-day perioperative mortality was 1.4%, lower in the DM group (0.9% vs 4.2%) (P=.005). The target vessel was more frequently infrageniculate in the DM group (87% vs 77%; P=.002). Five-year primary and secondary graft patencies were 74.7% (DM group, 75.6%; NDM group, 71.9%; P=.80) and 76.2% (DM group, 77.0%; NDM group, 73.6%; P=.90), respectively. The 5-year overall limb salvage rate was 87.1%, also unaffected by diabetes (DM group, 87.3%; NDM group, 85.4%; P=.80). Survival at 5 years was 58.1% overall and virtually identical in the DM (58.2%) and NDM groups (58.0%).
Conclusions Diabetes mellitus does not influence late mortality, graft patency, or limb salvage rates after lower extremity arterial reconstruction. Concern for long-term mortality and limb loss in diabetic patients is unwarranted and should not prevent aggressive attempts at limb salvage.
From the Division of Vascular Surgery, Department of Surgery, Beth Israel, Deaconess Medical Center, Harvard Medical School, Boston, Mass.
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