Prognostic factors for failure of primary patency within a year of bypass to the foot in patients with diabetes and critical ischaemia.
OBJECTIVE
To find out whether we could identify prognostic factors for early failure of bypass to the foot in diabetic patients with critical ischaemia.


METHODS
Retrospective series of consecutive patients.


METHODS
County hospital, Sweden.


METHODS
43 diabetic patients who had 48 reconstructions for critical ischaemia between 1988 and 1994.


METHODS
48 elective vein bypass procedures to the feet.


METHODS
Prognostic factors for primary patency.


RESULTS
Primary and secondary patency rates at one year were 72% (95% confidence interval (CI) 58 to 85) and 83% (95% CI 71 to 95), respectively. Limb salvage and survival rates at one year were 85% (95% CI 74 to 96) and 86% (95% CI 75 to 96), respectively. Vein graft of questionable quality, major wound healing problems, use of the reversed vein technique, and a narrow lumen (< 1.5 mm) of the recipient artery increased the hazard for failed primary patency by 17.3 (p = 0.003), 6.0 (p = 0.02), 4.7 (p = 0.03), and 3.9 (p = 0.05) times, respectively. Short vein bypass (p = 0.70), translocated or composite veins (p = 0.61), major postoperative oedema of the leg (p = 0.46), or questionable quality of the wall of the recipient artery (p = 0.29), however, had no significant independent effect on the primary patency rate.


CONCLUSIONS
Early primary patency after bypass to the foot in diabetic patients might improve if veins of questionable quality, major wound healing problems, thin reversed veins from the calf, and narrow recipient arteries can be avoided or handled more proficiently than in the present study.
Isaksson
L
L
Department of Surgery, Vrinnevisjukhuset, Norrköping, Sweden.
Lundgren
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical; D003925:Diabetic Angiopathies / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014654:Vascular Patency