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

Jung H, Cho J, Kim HK, Kim J, Huh S - Ann Surg Treat Res (2014)

Bottom Line: Single lesions were found in 81 limbs (76.4%).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.

View Article: PubMed Central - PubMed

Affiliation: Division of Transplantation and Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea.

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.

No MeSH data available.


Related in: MedlinePlus

(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.
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Figure 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.

Mentions: The GP for all patients at 1, 3, and 5 years was 84.8%, 74.5%, and 69.8%, respectively. Female gender negatively affected GP. The GP of male patients at 1, 3, and 5 years was 89.5%, 79.0%, and 72.9%, respectively; and for female patients was 60.0%, 50.0%, and 50.0%, respectively (P = 0.001). There was no difference between the GP of popliteal and the GP of infrapopliteal bypass procedures (Fig. 1). The GP at 1, 3, and 5 years for bypasses using a single GSV graft was 84.8%, 78.2%, and 78.2%, respectively. The GP of prosthetic graft was 88.9%, 77.9% and 69.2% at 1, 3, and 5 years. The GP of sequential bypass was 60.0% at 1, 3, and 5 years.


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

Jung H, Cho J, Kim HK, Kim J, Huh S - Ann Surg Treat Res (2014)

(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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4279985&req=5

Figure 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.
Mentions: The GP for all patients at 1, 3, and 5 years was 84.8%, 74.5%, and 69.8%, respectively. Female gender negatively affected GP. The GP of male patients at 1, 3, and 5 years was 89.5%, 79.0%, and 72.9%, respectively; and for female patients was 60.0%, 50.0%, and 50.0%, respectively (P = 0.001). There was no difference between the GP of popliteal and the GP of infrapopliteal bypass procedures (Fig. 1). The GP at 1, 3, and 5 years for bypasses using a single GSV graft was 84.8%, 78.2%, and 78.2%, respectively. The GP of prosthetic graft was 88.9%, 77.9% and 69.2% at 1, 3, and 5 years. The GP of sequential bypass was 60.0% at 1, 3, and 5 years.

Bottom Line: Single lesions were found in 81 limbs (76.4%).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.

View Article: PubMed Central - PubMed

Affiliation: Division of Transplantation and Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea.

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.

No MeSH data available.


Related in: MedlinePlus