In situ saphenous vein bypass surgery in diabetic patients.
From 1986 through to 1990 a total of 483 consecutive in situ infra-inguinal vein bypass procedures were performed in 444 patients, of whom 112 (25%) were diabetics (57 insulin dependent diabetes mellitus and 55 non-insulin-dependent diabetes mellitus). Based on a prospective vascular data registry this material was analysed to determine the influence of diabetes on the outcome. Preoperative risk factors were equally distributed among diabetic and non-diabetic patients, except for smoking habits (diabetics: 48%; non-diabetics: 64%, p = 0.002) and cardiac disease (diabetics: 45%; non-diabetics: 29%, p = 0.005). Indication for surgery was gangrene or ulceration in 57% of diabetics, as opposed to 36% in non-diabetic patients (p = 0.0002). A femoro-popliteal bypass was performed in 18% of patients, whereas 82% received an infrapopliteal procedure, of which 42% were to the distal third of the calf or foot. Diabetic patients had a significantly lower distal anastomosis than non-diabetic patients (p = 0.0001). The overall 3-year primary and secondary patency rates were 58 and 64%, respectively, with no differences between non-diabetics, non-insulin-dependent diabetics and insulin-dependent diabetics. Neither did limb survival differ among the three groups. However, the rate of minor amputations was significantly higher in insulin-dependent compared with non-insulin-dependent diabetics, who in turn had a higher rate than non-diabetic patients (p less than 0.00001). A markedly decreased survival rate was found in diabetics (p less than 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)
Jensen
L P
LP
Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Denmark.
Schroeder
T V
TV
Lorentzen
J E
JE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001807:Blood Vessel Prosthesis; D048909:Diabetes Complications; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003925:Diabetic Angiopathies / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery; D011446:Prospective Studies; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation*; D016909:Tibial Arteries / Q000601:surgery; D016896:Treatment Outcome; D014654:Vascular Patency