The impact of diabetes on arterial reconstructions for multilevel arterialocclusive disease

Purpose: Critical limb ischemia due to multilevel arterial occlusive diseas e often may be treated with an inflow procedure alone; however, a subset pa tients require a subsequent infrainguinal revascularization for persistence of their symptoms. As diabetic patients typically exhibit a pattern of ext ensive distal arterial disease, we sought to determine if the presence of d iabetes mellitus altered the need for an outflow procedure after inflow byp ass. Methods: A total of 504 patients undergoing inflow bypass for occlusive dis ease and lower extremity ischemia between 1990 and 1998 were entered prospe ctively into a computerized vascular registry. Inflow bypass procedures per formed were as follows: aortofemoral (370; 73%), axillofemoral (56; 11%), f emorofemoral (81; 16%). Of these patients, 79 required subsequent outflow b ypass for unresolved ischemic symptoms. Multiple logistic regression analys is was used to analyze the effects of diabetes and multiple other risk fact ors on the need for an additional outflow procedure. Results: The indications for surgery were limb salvage (78%) and disabling claudication (22%). Overall morbidity was 17.7% (hematoma, 3.8%; wound infe ction, 2.5%; graft occlusion, 1.3%; myocardial infarction, 2.5%; acute rena l failure, 1.3%; pulmonary failure, 2.5%; pneumonia, 3.8%). Overall mortali ty was 0%. Diabetic patients comprised a greater proportion of the total nu mber of patients requiring inflow bypass (301 of 504) as well as a greater proportion of patients requiring inflow and outflow procedures (47 of 79). Diabetes was determined not to be an independent risk factor for the need f or multiple revascularization procedures by multiple logistic regression an alysis (P > 0.10). Conclusion: Although patients with diabetes are predisposed to the developm ent of distal arterial occlusive disease, in this study the subgroup of dia betic patients who present with aortoiliac occlusive disease were no more l ikely than patients without diabetes to require multiple levels of revascul arization. These findings provide little rationale for simultaneous inflow and outflow procedures based on the presence of diabetes alone. (C) 2001 Ex cerpta Medica, Inc. All rights reserved.