Influence of diabetes on revascularisation procedures of the aorta and lower limb arteries: Early results

Object: to evaluate the influence of diabetes mellitus on the therapeutic i ndications and the one-month results in patients with occlusive disease of the aorta and/or lower limbs arteries. Material: a retrospective study of fully computerised date of 1003 patients (753 men, 250 women) admitted consecutively to our vascular surgery unit o ver a 5-year period (1992-1996). Of the total, 169 were diabetics (group I) and 834 were non-diabetics (group II). Sixty-two per cent of patients in g roup I vs. 40% in group II presented with critical ischaemia or trophic cha nges (p<0.001). Results: 15.4% of patients in group I vs. 4.1% in group II had primary ampu tation because of irreversible ischaemia or because arterial reconstruction was impossible. Of those who underwent revascularisation, 80% were infrain guinal in group I vs. 50% in group II. Forty-five per cent of patients in g roup I and 37% in group II had a percutaneous transluminal angioplasty (PTA ) and approximately 3% in both groups had a combination of the two techniqu es. At one month, patients alive without major amputation numbered 64.4% in group I vs. 93.6% in group II, patients alive with major amputation number ed 26.6% in group I vs. 5.5% in group II, and mortality rates were 8.9% in group I vs. 0.8% in group II (p<0.001). Conclusions: the 5-times higher amputation and 10-times higher mortality ra tes for diabetics compared to non-diabetics call for better collaborative m anagement of diabetics between general practitioners, vascular surgeons, di abetologists and cardiologists. PTA with a 90% initial success rate is indi cated for short lesions even in the presence of limited gangrene.