EARLY OUTCOME OF IN-SITU FEMOROTIBIAL RECONSTRUCTION AMONG PATIENTS WITH DIABETES ALONE VERSUS DIABETES AND END-STAGE RENAL-FAILURE - ANALYSIS OF 83 LIMBS
Ag. Hakaim et al., EARLY OUTCOME OF IN-SITU FEMOROTIBIAL RECONSTRUCTION AMONG PATIENTS WITH DIABETES ALONE VERSUS DIABETES AND END-STAGE RENAL-FAILURE - ANALYSIS OF 83 LIMBS, Journal of vascular surgery, 27(6), 1998, pp. 1049-1054
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.