Instant and long-term results of surgical treatment in patients with peripheral vascular disease as a complication of diabetes mellitus

Abstract

Aim. To define the indications and to evaluate the effectiveness of various surgical treatment methods in patients with arterial stenosis and occlusion due to atherosclerotic vascular disease of lower extremities as a complication of diabetes mellitus. Methods. Results of surgical treatment of 52 randomly assigned patients who underwent surgeries due to peripheral vascular disease as a complication of diabetes mellitus (type 2 - 51 patients, type 1 - 1 patient) were analyzed. The following surgeries were performed: arterial reconstructive surgery - 24 (46.2%) patients (group 1), balloon catheter angioplasty and stenting - 12 (23.1%) patients (group 2), indirect revascularization surgery (revascularising osteotrepanation, endovascular prostaglandin E therapy) - 16 (30.7%) patients (group 3). Following parameters were assessed: decrease of ischemic rest pain, arterial insufficiency stage, hospitalization terms, healing of foot ulcers, mortality rate, and amputation rate. The longest foot ulcers healing terms [only in 5 patients (31.2%) at first year] were registered in the third group. 1 death was registered each in the first and in second groups (mortality rate 4.2 and 8.3% respectively), no deaths were registered in group 3. The results of trophic ulcers treatment in the patients from the third group were poor. It is tactically appropriate to prefer endovascular surgeries to open surgeries as far as in this case there is no need for local and general anesthesia allowing to decrease the number of complications and the length of rehabilitation together with comparable results. Primary open arterial reconstructive surgeries are possible in patients with diabetes mellitus as a next step after endovascular surgery or when endovascular surgery can not be done. Conclusion. Similar instant and long-term results were found after direct comparison of bypass and endovascular surgeries, allowing to recommend these surgeries in patients with peripheral vascular disease as a complication of diabetes mellitus.