Lower Extremity Revascularization in Diabetes

Akbari, Cameron M.; Pomposelli, Frank B.; Gibbons, G. W.; Campbell, David R.; Pulling, Michele C.; Mydlarz, Darius; LoGerfo, Frank W.

doi:10.1001/archsurg.135.4.452

Cited by 104 publications

(74 citation statements)

References 27 publications

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“…However, patency rates in patients with ESRD continue to be significantly lower than rates in patients with normal renal function [10,11,12]. On the other hand, it is now generally accepted that the patency rate for infrainguinal revascularization is similar in diabetic and non-diabetic patients; however, higher late mortality and limb loss have been reported in diabetic compared to non-diabetic patients [4,5,6]. The present study confirms that the presence of diabetes mellitus and ESRD are associated with good primary and secondary patency rates, and most important, with a well-accepted limb salvage rate of 65% in the first year.…”

Section: Discussionmentioning

confidence: 99%

“…Most series show that bypass grafting in these patients is associated with well-accepted patency rates, though patient survival rates and limb salvage rates are lower than anticipated [1,2,3]. Success of infrainguinal arterial bypass in the diabetic limb has been widely proven; nevertheless, optimism remains guarded because a higher late mortality and limb loss have been reported in diabetics compared to non-diabetics [4,5,6]. …”

Section: Introductionmentioning

confidence: 99%

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Lower Extremity Bypass Procedures in Diabetic Patients with End-Stage Renal Disease: Is It Worthwhile?

et al. 2004

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Backgroud/Aims: Limb-threatening ischemia in patients with end-stage renal disease (ESRD) represents a challenging therapeutic problem. Furthermore, diabetes mellitus is frequently associated with ischemic gangrene, persistent infection and impaired wound healing. The present study was undertaken to examine graft patency, limb salvage and survival in patients with ESRD and diabetes following bypass grafting to treat lower limb critical ischemia. Methods: A retrospective analysis of 56 arterial reconstructions performed in 39 patients with diabetes mellitus and ESRD during a period of 8 years. The indications for bypass grafting were: ischemic rest pain (n = 13), non-healing ulcer (n = 18) or foot gangrene (n = 25). Risk factors in association with surgical morbidity and mortality, limb loss and graft patency were evaluated. Results: Thirty-four patients were on hemodialysis and 5 on peritoneal dialysis. Forty-nine infrainguinal reconstructions were performed; the site of distal anastomosis was the below knee popliteal artery (n = 22), the anterior tibial artery (n = 12), the posterior tibial artery (n = 8), and the peroneal artery (n = 7). Seven axillofemoral reconstructions were also performed; the site of distal anastomosis was the common femoral artery (n = 5) and the above knee popliteal artery (n = 2). The 30-day operative mortality rate was 18% (7 patients). The mean follow-up was 11.5 (range 1–93) months. Patient survival rate at 1 and 2 years was 63 and 45%, respectively. Primary patency rate was 64% at 1 year and 58% at 2 years. The limb salvage rate was 65% in the first year. Conclusion: Limb salvage rate in patients with ESRD and diabetes justifies an aggressive policy of revascularization, despite decreased survival of this population.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lower Extremity Bypass Procedures in Diabetic Patients with End-Stage Renal Disease: Is It Worthwhile?

et al. 2004

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“…Severe arterial obstruction in persons with diabetes is often amenable to endovascular intervention, open vascular reconstruction, or both. Recent studies have demonstrated excellent outcomes in the hands of experienced surgeons [70,77]. In special situations, the clinician caring for a patient with a DFI may need to consult specialists in fields not represented in the available team.…”

Section: Evidence Summarymentioning

confidence: 99%

“…The clinician should rarely use just a single invasive or noninvasive technique to determine whether to undertake a vascular intervention without taking into account other clinical parameters [60]. For more severe vascular disease of the foot in patients with diabetes, many centers have reported successful use of both aggressive endovascular intervention and distal bypass procedures [70,77,274,275]. For a patient with a severely infected ischemic foot, it is usually preferable to perform any needed revascularization early rather than to delay this procedure in favor of prolonged (and potentially ineffective) antibiotic therapy [276,277].…”

Section: Recommendationsmentioning

confidence: 99%

Risk Factors of Methicillin-Resistant Staphylococcus Aureus and Pseudomonas Infection in Diabetic Foot Ulcers in Korea

Lee

Son

Han

2017

J Wound Management Res

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“…In a prospective study which involved 795 arterial bypasses (87% subarticular) carried out on account of trophic disorders in diabetic patients, the amount of limbs saved at 5 years was 87.5% which corresponded to a secondary permeability of 76% for femoro-distal bypasses. 23 …”

Section: Bypassmentioning

confidence: 99%

Surgical revascularization techniques for diabetic foot

Kota¹,

Kota²,

Meher³

et al. 2013

Journal of Cardiovascular Disease Research

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a b s t r a c tDiabetes is an important risk factor for atherosclerosis. The diabetic foot is characterized by the presence of arteriopathy and neuropathy. The vascular damage includes non-occlusive microangiopathy and macroangiopathy. Diabetic foot wounds are responsible for 5e10% of the cases of major or minor amputations. In fact, the risk of amputation of the lower limbs is 15e20% higher in diabetic populations than in the general population. The University of Texas classification is the reference classification for diabetic wounds. It distinguishes non-ischemic wounds from ischemic wounds which are associated with a higher rate of amputation. The first principles of treatment are the control of pain of an eventual infection. When ischemia is diagnosed, restoration of pulsatile blood flow by revascularization may be considered for salvaging the limb. The treatment options are angioplasty with or without stenting and surgical bypass or hybrid procedures combining the two. Distal reconstructions with anastomosis to the leg or pedal arteries have satisfactory limb-salvage rates. Subintimal angioplasty is a more recent endovascular technique. It could be suggested for elderly patients who are believed to be unsuitable candidates for a conventional bypass or angioplasty. The current article would focus on the various revascularization procedures.

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Lower Extremity Revascularization in Diabetes

Cited by 104 publications

References 27 publications

Lower Extremity Bypass Procedures in Diabetic Patients with End-Stage Renal Disease: Is It Worthwhile?

Lower Extremity Bypass Procedures in Diabetic Patients with End-Stage Renal Disease: Is It Worthwhile?

Risk Factors of Methicillin-Resistant Staphylococcus Aureus and Pseudomonas Infection in Diabetic Foot Ulcers in Korea

Surgical revascularization techniques for diabetic foot

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