RESULTS AND COST-ANALYSIS OF DISTAL [CRURAL PEDAL] ARTERIAL REVASCULARIZATION FOR LIMB SALVAGE IN DIABETIC AND NONDIABETIC PATIENTS/

In order to compare the outcome and costs of femorodistal grafting in diabetic and nondiabetic patients presenting with critical limb ischae mia we analysed a consecutive series of 109 femorodistal bypasses, 38 (35 %) performed on people with diabetes and 71 (65 %) on non-diabetic patients. The same aggressive revascularization policy was used in bo th groups with the decision to operate based on the presence of a calf or foot vessel on preoperative intra-arterial digital subtraction ang iography (IADSA). Data were collected prospectively and the median fol low-up was 15.4 months (range 0 to 42 months). There were no significa nt differences in 30-day (5.3 % vs 4.2 %) and in-hospital mortality (1 3.2 % vs 14.1 %) between the two groups. Life table curves at 3 years in diabetic and non-diabetic patients showed 48 % vs 60 % survival, 76 % vs 72 % knee salvage, 45 % vs 56 % limb salvage, and 38 % vs 47 % s econdary patency. Although there was a trend far diabetic patients to perform less well, there was no statistically significant difference i n these outcome measures, in cost comparison the only significant diff erence was found in the total hospital cost, which was pound 9181 in d iabetic, compared to pound 6350 in nondiabetic patients (p = 0.026, Ma nn-Whitney). However, this cost was significantly less than that of pr imary amputation in either group (pound 15500 and pound 12040, respect ively). Femorodistal reconstruction in both diabetic and non-diabetic patients, whenever feasible, is a cheaper option than primary amputati on, even though, vascular surgery may be more expensive in people with diabetes.