Lower extremity arterial reconstruction for critical limb ischemia in diabetes

Abstract

Diabetic patients receiving IAR for CLI can have the same survival and amputation-free survival rates as nondiabetic patients. Their comparable technical and clinical outcomes strongly demonstrate that diabetics with CLI can expect the same quantity and quality of life as nondiabetics with CLI, and aggressive attempts at limb salvage in patients with diabetes mellitus, including distal and foot level bypass grafting, should not be discouraged.

Risk Factors for Premature Death in Diabetes Patients who Undergo Amputations below Ankle Level

“…In addition, studies have shown that vascular surgical intervention in patients with diabetes and arterial insufficiency reduces mortality [15,16]. One study showed the same survival rate, and the same amputation-free survival rates, after lower extremity arterial reconstruction for people with and without diabetes [17]. We have not been able to find a study, that has examined, whether patients with diabetes, who have undergone vascular surgical intervention and later lower extremity amputation, have higher or lower mortality than patients with diabetes, who have had lower leg amputation without prior vascular surgery.…”

Peripheral arterial disease and revascularization of the diabetic foot

“…Diabetes has been considered by many to be a poor prognostic factor for limb salvage and postoperative mortality after revascularization ; some data suggest that survival with resolution of symptoms and without major amputation may be lower in people with peripheral arterial disease and diabetes than in those without diabetes . The authors of other recent studies disagree with this and suggest that diabetes has a negative association with graft failure . Overall, diabetes per se does not necessarily compromise outcomes of lower limb bypass surgery; mortality rates in people with diabetes and foot ulceration may be similar to those reported in people with foot ulceration of any origin and the outcomes of peripheral arterial reconstruction are broadly similar in people with diabetes to those in people without diabetes, except perhaps in the case of people with diabetes who have severe neuropathy .…”

Treatment outcomes in diabetic patients with chronic limb-threatening ischemia

“…14 Similarly, Ballotta et al reviewed a single surgeon experience of 1,307 infrainguinal bypasses and reported no differences in graft patency, limb salvage, survival or amputation free survival after 5 and 10-year follow-up. 20 These single-center and single-surgeon results are susceptible to selection bias and may not be generalizable. Additionally, these studies focus on long-term outcomes.…”