Pedal arterial bypass for limb salvage in patients with diabetes mellitus.
OBJECTIVE
to evaluate pedal bypass grafting in patients with diabetes mellitus with critical limb ischaemia.


METHODS
from 1994 to 1999, 49 consecutive pedal bypass grafts were performed in 46 patients with a median age of 69 years (range 37-85 years). The incidence of insulin-dependent diabetes mellitus was 87%. The distal anastomosis was located at the dorsalis pedis artery in 36, at the inframalleolar posterior tibial artery in 9 and at the plantar artery in 4 cases, respectively.


RESULTS
one patient died perioperatively. Two bypass occlusions and one major amputation accounted for a primary patency rate of 96% and a limb salvage rate of 98% at 30 days, respectively. During a median follow-up of 28 months (range 1-70 months), 21 patients died of nonrelated causes. Three additional graft occlusions and 4 major amputations were noted resulting in a primary patency rate of 89% and a limb salvage rate of 87% at 48 months, respectively.


CONCLUSIONS
Pedal bypass grafting utilising the greater saphenous vein with in-situ technique is a reliable and effective procedure to achieve durable limb salvage in patients with diabetes mellitus.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000637:transplantation*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000601:surgery*; D005121:Extremities / Q000098:blood supply* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000209:etiology* / Q000601:surgery*; D023821:Limb Salvage; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors