title: Lower extremity revascularization in diabetes: late observations.
abstract: OBJECTIVE
  Despite the success of infrainguinal arterial bypass in diabetic limb and foot salvage, optimism remains guarded because of purported high late mortality and limb loss in patients with diabetes.
  
  
  METHODS
  Inception cohort, with minimum 5-year follow-up.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Eight hundred forty-three consecutive patients undergoing lower extremity arterial reconstruction from July 1, 1990, through July 31, 1993.
  
  
  METHODS
  Infrainguinal arterial bypass with vein graft.
  
  
  METHODS
  Graft patency, limb salvage, and survival.
  
  
  RESULTS
  A total of 962 vein grafts (843 patients) were performed; 795 grafts (82.6%) were performed in patients with diabetes (DM group) and 167 (17.4%) in nondiabetic patients (NDM group). Average age was 68.4 years, and was lower in the DM group (66.2 [range, 27-92 years] vs. 70.5 years [range, 37-96 years]) (P = .005). Inhospital 30-day perioperative mortality was 1.4%, lower in the DM group (0.9% vs. 4.2%) (P = .005). The target vessel was more frequently infrageniculate in the DM group (87% vs. 77%; P = .002). Five-year primary and secondary graft patencies were 74.7% (DM group, 75.6%; NDM group, 71.9%; P = .80) and 76.2% (DM group, 77.0%; NDM group, 73.6%; P = .90), respectively. The 5-year overall limb salvage rate was 87.1%, also unaffected by diabetes (DM group, 87.3%; NDM group, 85.4%; P = .80). Survival at 5 years was 58.1% overall and virtually identical in the DM (58.2%) and NDM groups (58.0%).
  
  
  CONCLUSIONS
  Diabetes mellitus does not influence late mortality, graft patency, or limb salvage rates after lower extremity arterial reconstruction. Concern for longterm mortality and limb loss in diabetic patients is unwarranted and should not prevent aggressive attempts at limb salvage.
authors.affiliation: Department of Surgery, Beth Israel, Deaconess Medical Center, Harvard Medical School, Boston, Mass, USA. cakbari@caregroup.harvard.edu
authors.forename: C M
authors.initials: CM
authors.lastname: Akbari
authors.forename: F B
authors.initials: FB
authors.lastname: Pomposelli
authors.forename: G W
authors.initials: GW
authors.lastname: Gibbons
authors.forename: D R
authors.initials: DR
authors.lastname: Campbell
authors.forename: M C
authors.initials: MC
authors.lastname: Pulling
authors.forename: D
authors.initials: D
authors.lastname: Mydlarz
authors.forename: F W
authors.initials: FW
authors.lastname: LoGerfo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation; D003925:Diabetic Angiopathies / Q000401:mortality / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome; D014654:Vascular Patency