Comparative Analysis of Patency, Limb Salvage and Survival in Diabetic and Non‐diabetic Patients Undergoing Infrainguinal Bypass Surgery

Karacagil, Sadettin; Almgren, Bo; Bowald, Staffan; Bergqvist, David

doi:10.1111/j.1464-5491.1995.tb00537.x

Cited by 26 publications

(32 citation statements)

References 15 publications

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“…These benefits however, are associated with a high perioperative mortality of 18% in our patients, which was a reflection of their advanced coronary and other concomitant diseases. Nevertheless, survival in diabetic patients appears to be limited [4, 13], and survival in patients with ESRD is even more limited [8]. In a series with similar characteristics to ours, Whittemore et al [14] also reported a 30-day mortality of 11%.…”

Section: Discussionsupporting

confidence: 51%

“…However, patency rates in patients with ESRD continue to be significantly lower than rates in patients with normal renal function [10,11,12]. On the other hand, it is now generally accepted that the patency rate for infrainguinal revascularization is similar in diabetic and non-diabetic patients; however, higher late mortality and limb loss have been reported in diabetic compared to non-diabetic patients [4,5,6]. The present study confirms that the presence of diabetes mellitus and ESRD are associated with good primary and secondary patency rates, and most important, with a well-accepted limb salvage rate of 65% in the first year.…”

Section: Discussionmentioning

confidence: 99%

“…Most series show that bypass grafting in these patients is associated with well-accepted patency rates, though patient survival rates and limb salvage rates are lower than anticipated [1,2,3]. Success of infrainguinal arterial bypass in the diabetic limb has been widely proven; nevertheless, optimism remains guarded because a higher late mortality and limb loss have been reported in diabetics compared to non-diabetics [4,5,6]. …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Lower Extremity Bypass Procedures in Diabetic Patients with End-Stage Renal Disease: Is It Worthwhile?

et al. 2004

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Backgroud/Aims: Limb-threatening ischemia in patients with end-stage renal disease (ESRD) represents a challenging therapeutic problem. Furthermore, diabetes mellitus is frequently associated with ischemic gangrene, persistent infection and impaired wound healing. The present study was undertaken to examine graft patency, limb salvage and survival in patients with ESRD and diabetes following bypass grafting to treat lower limb critical ischemia. Methods: A retrospective analysis of 56 arterial reconstructions performed in 39 patients with diabetes mellitus and ESRD during a period of 8 years. The indications for bypass grafting were: ischemic rest pain (n = 13), non-healing ulcer (n = 18) or foot gangrene (n = 25). Risk factors in association with surgical morbidity and mortality, limb loss and graft patency were evaluated. Results: Thirty-four patients were on hemodialysis and 5 on peritoneal dialysis. Forty-nine infrainguinal reconstructions were performed; the site of distal anastomosis was the below knee popliteal artery (n = 22), the anterior tibial artery (n = 12), the posterior tibial artery (n = 8), and the peroneal artery (n = 7). Seven axillofemoral reconstructions were also performed; the site of distal anastomosis was the common femoral artery (n = 5) and the above knee popliteal artery (n = 2). The 30-day operative mortality rate was 18% (7 patients). The mean follow-up was 11.5 (range 1–93) months. Patient survival rate at 1 and 2 years was 63 and 45%, respectively. Primary patency rate was 64% at 1 year and 58% at 2 years. The limb salvage rate was 65% in the first year. Conclusion: Limb salvage rate in patients with ESRD and diabetes justifies an aggressive policy of revascularization, despite decreased survival of this population.

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lower Extremity Bypass Procedures in Diabetic Patients with End-Stage Renal Disease: Is It Worthwhile?

et al. 2004

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“…Angiography is required to define the anatomy and the outcome of traditional techniques for revascularization in the form of distal bypass that seems to be comparative in patients with and without diabetes. 6 The Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) randomized trial compared surgery and endovascular techniques and concluded that for severe leg ischemia, a patient with a life expectancy of >2 years should be offered bypass surgery in preference but offered EVT if life expectancy was <2 years. 7 This reflects the fact that bypass is more likely to result in longer term patency and limb salvage.…”

mentioning

confidence: 99%

Revascularization for Critical Limb Ischemia in Diabetes

2013

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“…Another study assessed the 1-and 3-year cumulative life-table patency, limb salvage and survival rates [27]. The cumulative graft patency rates were 61% at 12 months and 46% at 36 months in diabetic patients compared with 64% and 52% in non-diabetic patients [27].…”

Section: Diabetes Mellitusmentioning

confidence: 99%

The role of established and emerging risk factors in peripheral vascular graft occlusion

Fatourou

Paraskevas

Seifalian

et al. 2007

Expert Opinion on Pharmacotherapy

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Several studies have evaluated the association between established as well as emerging vascular risk factors with peripheral graft occlusion. There is evidence for a link between the risk for graft occlusion and total serum cholesterol, low-density lipoprotein cholesterol and triglyceride levels. The overall effect of smoking shows a 2.35-fold increase in risk of graft failure. Studies involving diabetic patients undergoing peripheral bypass may have failed to detect higher occlusion rates, possibly due to increased morbidity and mortality as well as higher amputation rates even if the graft is patent. Both antiplatelet agents and anticoagulation seem to be effective in the prevention of graft occlusion. Unconvincing data have been published with regards to the effect of hypertension on graft patency. Emerging factors such as fibrinogen, lipoprotein (a), C-reactive protein and homocysteine levels should also be considered when assessing the risk of graft occlusion. More research is needed to prevent graft occlusion due to the obvious clinical relevance, quality of life and cost issues.

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Comparative Analysis of Patency, Limb Salvage and Survival in Diabetic and Non‐diabetic Patients Undergoing Infrainguinal Bypass Surgery

Cited by 26 publications

References 15 publications

Lower Extremity Bypass Procedures in Diabetic Patients with End-Stage Renal Disease: Is It Worthwhile?

Lower Extremity Bypass Procedures in Diabetic Patients with End-Stage Renal Disease: Is It Worthwhile?

Revascularization for Critical Limb Ischemia in Diabetes

The role of established and emerging risk factors in peripheral vascular graft occlusion

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