title: Safety of vein bypass grafting to the dorsal pedal artery in diabetic patients with foot infections.
abstract: The results of 56 vein bypasses to the dorsal pedal artery performed in 53 diabetic patients who were admitted with ischemic foot lesions complicated by infection were reviewed. All patients had one or more of the following: infected ulcers (73%), cellulitis (45%), osteomyelitis (29%), gangrene (20%), or abscess (2%). Organisms were cultured from 84% of patients (average 2.6, range 1 to 9 organisms per infection). Elevated temperature (greater than 37.7 degrees C) or leukocytosis (greater than 9.0 x 10(3)/ml) were seen in 13% and 50% of patients, respectively. All patients were treated with broad-spectrum antibiotics, local debridement, wound care, and bed rest. Operative debridement or open partial forefoot amputation were required to control sepsis in 11 patients (20%). Treatment of infection delayed revascularization by an average of 10.7 days. All patients underwent autogenous vein bypasses to the dorsal pedal artery. Two grafts failed within 30 days (3.6%), and one patient died (1.8%). Wound infections developed in seven patients (12.5). One wound infection resulted in graft disruption and patient death at 2 months. Average length of stay of the initial hospitalization was 29.8 days. Fifty-two patients were discharged with patent grafts and salvaged limbs; however, 31 subsequent foot procedures and 35 rehospitalizations were required to ultimately achieve foot healing. Actuarial graft patency and limb salvage were 92% and 98%, respectively at 36 months. Pedal bypass to the ischemic infected foot is efficacious and safe as long as infection is adequately controlled first. The complexity of these situations often requires multiple surgical procedures and extensive wound care, resulting in prolonged or multiple hospitalizations.
authors.affiliation: Division of Vascular Surgery, New England Deaconess Hospital, Boston, MA 02215.
authors.forename: G A
authors.initials: GA
authors.lastname: Tannenbaum
authors.forename: F B
authors.initials: FB
authors.lastname: Pomposelli
authors.forename: E J
authors.initials: EJ
authors.lastname: Marcaccio
authors.forename: G W
authors.initials: GW
authors.lastname: Gibbons
authors.forename: D R
authors.initials: DR
authors.lastname: Campbell
authors.forename: D V
authors.initials: DV
authors.lastname: Freeman
authors.forename: A
authors.initials: A
authors.lastname: Miller
authors.forename: F W
authors.initials: FW
authors.lastname: LoGerfo
mesh_terms: D000206:Actuarial Analysis; D001158:Arteries / Q000601:surgery; D001424:Bacterial Infections / Q000209:etiology / Q000628:therapy*; D048909:Diabetes Complications; D005260:Female; D005528:Foot / Q000098:blood supply*; D005534:Foot Diseases / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D008297:Male; D012189:Retrospective Studies; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation