Lower extremity arterial reconstruction for critical limb ischemia in diabetes

Autor: Antonio Toniato, Enzo Ballotta, Giuseppe Da Giau, Giacomo Piatto, Franco Mazzalai
Rok vydání: 2014
Předmět:
Male
Time Factors
medicine.medical_treatment
Kaplan-Meier Estimate
Ischemia
Risk Factors
Odds Ratio
Medicine
Registries
Autografts
Fisher's exact test
Aged
80 and over
Graft Occlusion
Vascular
Middle Aged
Limb Salvage
Treatment Outcome
Lower Extremity
symbols
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
Reoperation
critical limb ischemia
medicine.medical_specialty
Critical Illness
Amputation
Surgical
Disease-Free Survival
Veins
symbols.namesake
Diabetes mellitus
Humans
Vascular Patency
Aged
Proportional Hazards Models
Retrospective Studies
Chi-Square Distribution
business.industry
Patient Selection
Retrospective cohort study
Perioperative
Critical limb ischemia
Plastic Surgery Procedures
Vascular surgery
medicine.disease
Surgery
Amputation
Quality of Life
Vascular Grafting
business
Diabetic Angiopathies
Zdroj: Journal of Vascular Surgery. 59:708-719
ISSN: 0741-5214
Popis: Background The impact of diabetes mellitus on the technical and clinical outcomes of infrainguinal arterial reconstruction (IAR) for critical limb ischemia (CLI) remains controversial. This study analyzed the outcome of IAR in diabetic patients with CLI over a 17-year period. Methods Details on all consecutive patients undergoing primary IAR at our institution were stored prospectively in a vascular registry from 1995 to 2011. Demographics, risk factors, indications for surgery, inflow sources and outflow target vessels, types of conduit, and adverse outcomes were analyzed. Postoperative surveillance included clinical examination, duplex scans, and ankle-brachial index measurements in all patients at discharge, 1 and 6 months after surgery, and every 6 months thereafter. End points were patency, limb salvage, survival, and amputation-free survival rates, and were assessed using Kaplan-Meier life-table analysis. The χ 2 or Fisher exact, Student t , and log-rank tests were used to establish statistical significance. Results Overall, 1407 IARs were performed in 1310 patients with CLI by the same surgeon, 705 (50.2%) in 643 diabetic patients and 702 in 667 nondiabetic patients. Autogenous vein conduits were used in 87% of the IARs. There were no perioperative deaths. Diabetic patients had significantly more major (16.7% vs 11.8%; P = .02) and minor complications (9.7% vs 6.5%; P = .02) than nondiabetic patients. At 5 and 10 years, there were no significant differences between diabetic and nondiabetic patients in the rates of primary patency (65% and 46% vs 69.5% and 57%; log-rank test, P = .09), secondary patency (76% and 60% vs 80% and 68%; log-rank test, P = .20), limb salvage (88% and 76% vs 91% and 83%; log-rank test, P = .12) survival (51% and 34% vs 57% and 38%; log-rank test, P = .41), or amputation-free survival (45.5% and 27% vs 51% and 29%; log-rank test, P = .19). The type of conduit did not affect patency or limb salvage rates in either group. Conclusions Diabetic patients receiving IAR for CLI can have the same survival and amputation-free survival rates as nondiabetic patients. Their comparable technical and clinical outcomes strongly demonstrate that diabetics with CLI can expect the same quantity and quality of life as nondiabetics with CLI, and aggressive attempts at limb salvage in patients with diabetes mellitus, including distal and foot level bypass grafting, should not be discouraged.
Databáze: OpenAIRE
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