Diabetes and the outcome of infrainguinal bypass for critical limb ischaemia

Abstract

Diabetes mellitus adversely affects hospital mortality and long-term survival. Graft patency and limb salvage are not compromised by the presence of DM.

Major Amputation Incidence Decreases Both in Non-Diabetic and in Diabetic Patients in Helsinki

“…Considered together,these may suggest poorer outcome in treated patients or,even worse, may completely discourage any aggressive vascular surgical treatment in these patients (22). however, despite decreased surdespite decreased survival among diabetics (19,23,24) therei se vidence that bypass grafting to the leg is worthwhile (19)(20)(21)(22)(23)(24). In anation-wide analysis of diabetes as arisk factor for postoperative major mortality and morbidity after surgery for CLI in Finland during 1991-1999, diabetes was found to be an independent risk factor for postoperative BK amputation (37).…”

“…Several studies have shown an inverse correlation between the incidence of infrainguinal bypass reconstruction and that of amputation (5, [14][15][16][17][18]. Equal patency and limb salvage rates after infrainguinal revascularization for diabetic and nondiabetic patients have been reported (19)(20)(21)(22)(23)(24). Furthermore, implementation of am ultidisciplinary team implementationo fam ultidisciplinary team approach for prevention and treatment of diabetic foot ulcers has reported to be effective means of preventing amputations (25)(26)(27)(28)(29)(30)(31).…”

Hind Limb Ischemia-Reperfusion in the Leptin Receptor Deficient (db/db) Mouse

“…The reasons for these differences are not completely understood. To complicate our understanding of this problem, recent studies have shown no significant differences in early limb salvage between diabetic and non-diabetic patients undergoing vascular reconstruction [5,6].…”

Lower extremity arterial reconstruction for critical limb ischemia in diabetes

“…2 Its prevalence is very high among people with critical limb ischemia (CLI), defined as pain at rest and/or the presence of ischemic ulcer or gangrene, ranging between 35% and 80% of patients undergoing lower extremity bypass surgery to avoid limb loss (opposed to around 10% in the general population), 3 making the management of CLI in diabetic patients an important surgical challenge in clinical practice. 4 There have been reports of infrainguinal arterial reconstruction (IAR) for CLI in diabetics being associated with higher rates of revascularization failure, limb loss, morbidity, [5][6][7][8] and mortality, 6,[8][9][10][11][12] and DM is reportedly an independent predictor of failure in percutaneous lower extremity procedures in patients with CLI, accounting for unacceptably frequent restenoses needing reinterventions. 13,14 Many studies involving aggressive revascularization efforts and exploiting technical advances in extreme distal arterial reconstruction and better postoperative care have challenged these results, however, reporting excellent technical outcomes after IAR for CLI, with no difference between diabetic and other patients.…”