Peripheral vascular bypass in juvenile-onset diabetes mellitus: are aggressive revascularization attempts justified?
This study was performed to evaluate the results of peripheral vascular reconstruction for arterial occlusive disease in patients with juvenile-onset diabetes mellitus. The results of 67 bypass procedures performed on 60 patients with juvenile-onset diabetes mellitus between Jan. 1, 1984 and Dec. 31, 1989, were reviewed. These patients had a mean age of 44.4 years (range, 29 to 59 years), with an average age of onset of diabetes mellitus of 9.8 years (range, 1 to 19 years). These procedures comprised 5.5% (67 to 1214) of the bypasses performed on diabetic patients during the same time period at a single institution. Fifty-four of 67 (91%) procedures were performed for limb salvage. Fifty-four (81%) procedures were primary infrainguinal bypasses with saphenous vein (femoropopliteal 19, femorodistal or popliteal-distal 35). Six procedures (9%) were revision procedures, four (6%) were in-flow procedures, and three (4%) were infrainguinal procedures with polytetrafluoroethylene. Thirty-day morbidity and mortality rates were 31% and 0%, respectively. Actuarial patency and limb salvage rates of the primary vein graft group were 66.0% (+/- 10.7) and 83.4% (+/- 8.0%), respectively, at 24 months. Cumulative survival of the entire group at 2 years was 84.1%. Although follow-up in this study is relatively short (24 months), the results suggest that the outcome of vascular reconstruction in patients with juvenile-onset diabetes mellitus is acceptable when compared with procedures performed in adult-onset diabetic and nondiabetic populations. The presence of juvenile-onset diabetes mellitus should not diminish the vascular surgeon's expectations of a successful outcome when considering lower extremity revascularization in these patients.
Kwolek
C J
CJ
Division of Vascular Surgery, New England Deaconess Hospital, Harvard Medical School, Boston, MA.
Pomposelli
F B
FB
Tannenbaum
G A
GA
Brophy
C M
CM
Gibbons
G W
GW
Campbell
D R
DR
Freeman
D V
DV
Miller
A
A
LoGerfo
F W
FW
D000206:Actuarial Analysis; D000328:Adult; D001807:Blood Vessel Prosthesis; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D012501:Saphenous Vein / Q000637:transplantation; D016019:Survival Analysis