Diabetes and the outcome of infrainguinal bypass for critical limb ischaemia.
OBJECTIVE
To examine the influence of diabetes mellitus (DM) on the outcome of infrainguinal bypass operations performed for critical foot ischaemia in Chinese patients.


METHODS
A prospective audit of 265 consecutive infrainguinal bypass operations.


RESULTS
Diabetic patients suffered more frequently from ischaemic heart disease (48% vs 25%, P=0.001) and tissue loss (90% vs 79%, P=0.01) at presentation. Cigarette smoking was more prevalent in the non-diabetic (NDM) group (72% vs 51%, P=0.001). Arterial segments distal to the common femoral artery were more often used as inflow to bypass graft in DM patients (36% vs 22%, P=0.02). Operative mortality (seven DM vs one NDM, P=0.19). Early graft failure (7% in DM group vs 10% in NDM group, P=0.24), wound infection rate (24% in DM group vs 17% in NDM group, P=0.21), early limb loss (9% in DM group vs 6% in NDM group, P=0.66) were comparable. However, hospital mortality was higher in DM patients (8% vs 1%, P=0.04). DM patients more frequently required further surgical debridement postoperatively (20% vs 9%, P=0.04). Long-term, patient survival was inferior in the DM group (43% NDM vs 33% DM at 5 years, P=0.03). Primary graft patency (46% DM vs 34% NDM at 4 years P=0.19), secondary graft patency (57% DM vs 47% NDM at 4 years P=0.14) and limb salvage rate (78% vs 81% at 5 years, P=0.79) were comparable.


CONCLUSIONS
Diabetes mellitus adversely affects hospital mortality and long-term survival. Graft patency and limb salvage are not compromised by the presence of DM.
AhChong
Ah Kian
AK
Department of Surgery, Kwong Wah Hospital, Kowloon, Hong Kong. ahchong@ha.org.hk
Chiu
Kai Ming
KM
Wong
Maket Wai Chun
MW
Hui
Hiu Kit
HK
Yip
Andrew Wai Chun
AW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D019917:Blood Vessel Prosthesis Implantation; D048909:Diabetes Complications; D005260:Female; D006085:Graft Survival; D006801:Humans; D007264:Inguinal Canal / Q000098:blood supply / Q000601:surgery*; D007511:Ischemia / Q000150:complications* / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014654:Vascular Patency