Outcome After Leg Bypass Surgery for Critical Limb Ischemia Is Poor in Patients With Diabetes

Malmstedt, Jonas; Leander, Karin; Wahlberg, Eric; Karlström, Lars; Alfredsson, Lars; Swedenborg, Jesper

doi:10.2337/dc07-2424

Cited by 85 publications

(78 citation statements)

References 24 publications

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“…Weiss and Sumpio reported in a meta-analysis that graft patency was equivalent in patients with and without diabetes. 18 A Swedish study found a lower amputation-free survival rate in diabetic patients after leg bypass surgery, 19 contrary to the findings of the present study. These other reports, however, included differing preoperative patient profiles, severity of disease, operative procedures and follow-up systems.…”

Section: Discussioncontrasting

confidence: 57%

Diabetes and Old Age Could Affect Long-Term Patency of Paramalleolar Distal Bypass for Peripheral Arterial Disease in Japanese Patients

Komai

Obitsu

Shigematsu

2011

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp istal bypass has been established as the most effective treatment for critical limb ischemia of peripheral arterial disease (PAD). In particular, bypass to the paramalleolar arteries is considered to enable complete revascularization through the pedal lesion. It is still a challenging procedure, however, because the long-term patency rate is not satisfactory, despite recent progress in surgical techniques and postoperative management. Early graft failure might be due to poor anastomotic technique, presence of inadequate run-off vessels, or marked calcification of the target artery and/or poor quality of the conduit vein. Although many papers have been published concerning the long-term patency of distal bypass, 1-3 the factors subsequently affecting the patency rate have not yet been elucidated. In the present report, data were reviewed and the factors affecting long-term patency were investigated. Patient background profile and technical factors involved in the distal bypass operation to the paramalleolar tibial artery were considerably similar in each patient due to the presence of similar risk factors of atherosclerosis and coexistent atherosclerotic vascular diseases. The extent of the disease was similar, variation in surgical techniques was limited, and surgical procedures and postoperative care were uniform in general. Thus, we believe that it would be beneficial to analyze the results of paramalleolar distal bypass to elucidate the risk factors of graft failure. In particular, Japanese subjects are very homogeneous genetically, 4,5 which favors determination of the substantial factors involved in graft failure. MethodsWe retrospectively studied 65 legs of 60 consecutively treated Japanese patients (49 men, 11 women; age range, 42-87 years; average, 70.5 years) with PAD who underwent distal bypass to the paramalleolar tibial artery (artery supplying the distal third of the calf) 6 for critical limb ischemia (Table 1). All the patients had lower extremity ischemic ulcer or necrosis. Ankle brachial pressure index, skin perfusion pressure and angiography showed the lesions to be of ischemic origin, and they met the criteria for critical limb ischemia in the Trans-Atlantic Inter-Society Consensus (TASC) guidelines. Comorbidity factors consisted of diabetes in 43 patients (66%), hypertension in 42 (65%), dyslipidemia in 12 (18%), chronic renal failure Background: The results of paramalleolar distal bypass for critical limb ischemia in patients with peripheral arterial disease were reviewed to determine the factors affecting the long-term patency of this procedure in Japanese subjects.

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Section: Discussioncontrasting

confidence: 57%

Diabetes and Old Age Could Affect Long-Term Patency of Paramalleolar Distal Bypass for Peripheral Arterial Disease in Japanese Patients

Komai

Obitsu

Shigematsu

2011

Circ J

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“…104 In a population-based cohort of linked nationwide databases in Sweden of 1840 patients, amputation rates were 65% higher over the course of 2.2 years after lower extremity bypass surgery for critical limb ischemia in patients with diabetes mellitus compared with those without diabetes mellitus. 105 Patients with diabetes mellitus have other conditions that contribute to foot wounds and exacerbate the complications of vascular insufficiency, such as neuropathy and altered foot mechanics. The presence of these additional complications may make determination of the pathogenesis of pedal ulcers more difficult to ascertain.…”

Section: Peripheral Artery Diseasementioning

confidence: 99%

Vascular Complications of Diabetes

Beckman

Creager

2016

Circulation Research

291

218

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Over the last several decades, the global incidence and prevalence of diabetes mellitus has increased significantly. The raised incidence rate is projected to continue as greater numbers of persons adopt a Western lifestyle and diet. Patients with diabetes mellitus are at heightened risk of both adverse microvascular and cardiovascular events. Moreover, once cardiovascular disease develops, diabetes mellitus exacerbates progression and worsens outcomes. The medical management of patients with diabetes mellitus mandates comprehensive risk factor modification and antiplatelet therapy. Recent clinical trials of new medical therapies continue to inform the care of patients with diabetes mellitus to reduce both cardiovascular morbidity and mortality.

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“…Patients with foot complications are more likely to develop CLI if they are diabetic and the subsequent major amputation is higher than that in non-diabetic patients [5]. Various reports have also confirmed the risk of major amputation or death after leg bypass surgery for CLI in patients with diabetes [6].…”

Section: Introductionmentioning

confidence: 76%

“…Most reports have confirmed that the results of leg bypass surgery for CLI are poor in patients with diabetes. In all instances, aggressive surgical debridement irrespective of any anatomy remains mandatory in diabetic foot ulceration in order to reduce the chances of infection [6].…”

Section: Introductionmentioning

confidence: 99%

A Therapeutic Answer for the Controversy of Insulin Cardio-Protection among Dysglycemic Patients

M¹

2015

Gen Med (Los Angel)

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The study aimed to illustrate the value of blood-let out cupping therapy in correcting early diabetic leg critical ischemia.Diabetic foot disease now replaced hyperglycemic coma as the major cause of diabetic mortality. The effect of medical treatment alone is far from ideal, especially in patients with diabetic foot complications; a high level amputation is inevitable. The real clue in a diabetic limb is preventing progress into complications rather than treating them. The challenge in the diabetic leg ischemia lies mainly in the accumulation of ischemic metabolites which would embarrass the micro-circulation by causing angiospasm. Withdrawal of these toxic metabolites and inflammatory mediators, being interstitial and diffuse, is not feasible via the available clinical measures; superficial scratching on the skin and suction by the traditional therapeutic cups is the only procedure to eliminate these acidic metabolites.Three patients with diabetic leg ischemia scheduled for above knee amputation due to complete unilateral obliteration of the vessels below the knee demanded an alternative solution for their conditions via cupping therapy. They were one male starting early acute ischemia of the right foot, a female starting gangrene of the right little toe and a male patient with early gangrene of the left heel. A basic cupping session on the upper back for the purpose of sero-clearance was done for them before the definitive cupping therapeutic sessions of the ischemic leg.Limb ischemia has been successfully corrected in all patients as documented by duplex ultrasound and amputation was cancelled.On conclusion, cupping therapy is promising in leg ischemia and is worthy of wider practical application.

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Outcome After Leg Bypass Surgery for Critical Limb Ischemia Is Poor in Patients With Diabetes

Cited by 85 publications

References 24 publications

Diabetes and Old Age Could Affect Long-Term Patency of Paramalleolar Distal Bypass for Peripheral Arterial Disease in Japanese Patients

Diabetes and Old Age Could Affect Long-Term Patency of Paramalleolar Distal Bypass for Peripheral Arterial Disease in Japanese Patients

Vascular Complications of Diabetes

A Therapeutic Answer for the Controversy of Insulin Cardio-Protection among Dysglycemic Patients

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