Long-term outcomes of infrainguinal bypass surgery for patients with diabetes mellitus and tissue loss

Abstract

Purpose: To determine the long-term outcomes of patients with diabetes mellitus (DM) and tissue loss who have undergone infrainguinal bypass surgery (IBS).

Methods: We retrospectively reviewed the medical records of 91 patients with DM and tissue loss who underwent IBS between July 2003 and December 2013. We determined the rates of overall survival (OS), amputation-free survival (AFS), limb salvage (LS), and graft patency (GP). In addition, we evaluated data to identify risk factors that affected long-term outcomes.

Results: The mean age of patients was 66 ± 8 years, and 78 patients (85.7%) were men. The locations of tissue loss were toe on 76 limbs (71.6%), heel on 6 limbs (5.7%) and others on 24 limbs (22.6%). Single lesions were found in 81 limbs (76.4%). According to categorization by distal anastomosis artery, there were 57 popliteal (53.8%) and 49 infrapopliteal bypasses (46.2%). Among infrapopliteal bypasses, 5 cases (10.2%) were sequential bypasses. The OS at 1, 3, and 5 years was 90.5%, 70.9%, and 44.2%, respectively. At 1, 3, and 5 years, the LS was 92.1%, 88.9%, 88.9%, respectively; and AFS was 84.4%, 67.6%, 45.7%, respectively. At 1, 3, and 5 years, the GP was 84.8%, 74.5%, and 69.8%, respectively. Renal failure was a negative predictor for OS, and female gender was a negative predictor for GP.

Conclusion: IBS for patients with DM and tissue loss led to acceptable OS, AFS, LS, and GP. Active revascularization for patients with DM and tissue loss can reduce the risk of major amputation.

Keywords: Diabetes mellitus; Infrainguinal bypass; Tissue loss.

Fig. 1

(A) Limb salvage rate of groups classified by distal anastomotic artery was not significantly different (P = 0.059). a, above the knee popliteal bypass; b, below the knee popliteal bypass; c, crural bypass; d, pedal bypass. (B) Graft patency of groups classified by distal anastomotic artery was not significantly different (P = 0.637) a, above the knee popliteal bypass; b, below the knee popliteal bypass; c, crural bypass; d, pedal bypass.

Fig. 2

(A) Survival rate of patients with renal insufficiency (RI) were significant lower than without RI (P = 0.011). (B) Female had lower graft patency than male (P = 0.022).