Comparison of peripheral arterial reconstruction in diabetic and non-diabetic patients: a prospective clinic-based study

Lower extremity arterial reconstruction for critical limb ischemia in diabetes

“…The diabetics fared just as well in IAR patency and limb salvage rates as their nondiabetic counterparts, even after stratifying by type of conduit. These findings correlate well with other reports on the impact of DM on conventional technical outcome measures 9,10,15,[17][18][19][20][21][22][23] but contrast with worse patency rates and higher limb loss rates recorded in diabetic patients [5][6][7][8]11 attributable to a poor infrageniculate runoff (a marker of more severe disease), late surgery, and often broad tissue loss (especially with deep infection), leading to major amputation despite a patent revascularization.…”

“…Although cardiac disease was present in more than 50% of our patients, with high rates of prior MI and PTA/stenting or coronary artery bypass grafting, the overall incidence of perioperative nonfatal MI was only 2.8%, and its higher prevalence among diabetic patients was statistically insignificant (3.4% vs 2.1%; P ¼ .14). The diabetic and nondiabetic patients' comparable rate of cardiac complications confirms other reports 10,19,22 but contrasts with the higher perioperative cardiac morbidity often encountered in diabetics 5,11 and attributed to a higher incidence of subclinical coronary artery disease that is sometimes clinically silent. 11 There were no perioperative deaths in our series (as already reported in our recently published study in which severe claudication and CLI were indications for IAR 30 ), whereas others have reported perioperative mortality rates of 0.9% to 7%, usually with no difference between diabetic and nondiabetic groups 3,15,[19][20][21][22] (Table IV).…”

“…2 Its prevalence is very high among people with critical limb ischemia (CLI), defined as pain at rest and/or the presence of ischemic ulcer or gangrene, ranging between 35% and 80% of patients undergoing lower extremity bypass surgery to avoid limb loss (opposed to around 10% in the general population), 3 making the management of CLI in diabetic patients an important surgical challenge in clinical practice. 4 There have been reports of infrainguinal arterial reconstruction (IAR) for CLI in diabetics being associated with higher rates of revascularization failure, limb loss, morbidity, [5][6][7][8] and mortality, 6,[8][9][10][11][12] and DM is reportedly an independent predictor of failure in percutaneous lower extremity procedures in patients with CLI, accounting for unacceptably frequent restenoses needing reinterventions. 13,14 Many studies involving aggressive revascularization efforts and exploiting technical advances in extreme distal arterial reconstruction and better postoperative care have challenged these results, however, reporting excellent technical outcomes after IAR for CLI, with no difference between diabetic and other patients.…”

“…9,10,15,[16][17][18][19][20][21][22][23] There is no standard method for reporting the outcome of lower extremity vascular reconstructions. Most studies only measure the effectiveness and durability of IAR for CLI in technical terms as patency and limb salvage (defined as preservation of the affected limb with no need for major amputation), 3,5,7,[9][10][11][12]15,[16][17][18][19][20][21][22][23] neglecting such clinical parameters as amputation-free survival (defined as survival with a saved functional limb). 6,8,22 While the former are the most important objective of the surgery, the latter would be the main goal from the patient's point of view.…”

The Evaluation of Cardiac and Peripheral Arterial Disease in Patients with Diabetes Mellitus

“…A greater proportion of diabetic patients with PAD have concomitant hypertension (152). In addition, diabetic patients have more distal disease, (152,153) more progressive and severe disease, and they are more likely to undergo surgery and amputation for critical limb ischemia (148,152,153). The rates of gangrene or amputation of lower limbs are as much as 10 to 20 times more frequent in diabetic than in control subjects (154,155).…”