EARLY OUTCOME OF IN-SITU FEMOROTIBIAL RECONSTRUCTION AMONG PATIENTS WITH DIABETES ALONE VERSUS DIABETES AND END-STAGE RENAL-FAILURE - ANALYSIS OF 83 LIMBS

Purpose: Both end-stage renal disease and diabetes have been demonstra ted to have a negative effect on the outcome of infrainguinal arterial reconstruction, primarily because of increased perioperative morbidit y and wound complications. This study was undertaken to determine whet her the combination of these comorbid factors affects the outcome of d istal arterial reconstruction. Methods: Eighty-three distal lower extr emity arterial bypasses originating from the femoral artery and termin ating at the peroneal, anterior, or posterior tibial artery were perfo rmed on 76 patients over a 5-year period at a tertiary care medical ce nter. Autogenous greater saphenous vein was used as the bypass conduit in all instances. Combined inflow and composite vein procedures were excluded. Results: There was one perioperative death, for a mortality rate of 1.2%. The diabetes mellitus (DM) plus end-stage renal disease (DM+ESRD) cohort displayed a significantly lower 1-year primary patenc y rate compared with the diabetes mellitus cohort, 53% versus 82% (p < 0.02). However, the limb salvage rate for the DM+ESRD and DM cohorts during the same time interval were not significantly different, 63% ve rsus 84% (p < 0.06). The 52% 1-year survival rate for the DM+ESRD coho rt was strikingly lower than the 90% 1-year survival rate for the DM c ohort (p < 0.002). Conclusion: Despite the use of the optimal autogeno us conduit, the combination of diabetes and end-stage renal disease ca n be expected to significantly decrease primary graft patency without affecting limb salvage. The greatest effect of these comorbid factors is on patient survival.