• Users Online: 172
  • Print this page
  • Email this page
Year : 2018  |  Volume : 1  |  Issue : 1  |  Page : 6-13

Limb salvage following successful infra-inguinal revascularization in diabetic patients

Vascular and Endovascular Research Center, Johns Hopkins Bayview Medical Center, Johns Hopkins University, Baltimore, MD, USA

Correspondence Address:
Mahmoud B Malas
Professor of Surgery, Johns Hopkins University, Director of The Center for Research Excellence and Surgical Trials, Johns Hopkins Hospital, Director of Endovascular Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/VIT.VIT_4_18

Rights and Permissions

BACKGROUND: Diabetes is a major risk factor for peripheral artery disease (PAD). Infrainguinal bypass surgery (IBS) has been the modality of choice for limb salvage in PAD patients. It is well known that diabetic patients have different disease progression than nondiabetics. Therefore, it is important to assess the outcomes and to determine the efficacy of current surgical practices for limb salvage in the diabetic population. The aim of this study is to evaluate short-term and long-term outcomes after IBS in diabetic patients. MATERIALS AND METHODS: We identified all patients who underwent IBS at our hospital from 2007 to 2014. Explanatory analysis using Pearson's Chi-square test, Fischer's exact test, and Student's t-test was performed. Kaplan–Meier analysis was used to evaluate primary patency, primary-assisted patency, and limb loss. Multivariate Cox regression analysis was implemented to examine loss of patency and amputation after adjusting for patients' demographics and comorbidities. RESULTS: A total of 428 IBSs were performed. Out of those, 264 (62%) were diabetic. Diabetic patients presented on average of 3 years earlier than nondiabetics (66.3 [11.0] vs. 68.9 [11.9], P = 0.03) and had significantly higher comorbidities including dyslipidemia (58% vs. 45% P = 0.01), coronary artery disease (70% vs. 46%, P = 0.01), and chronic kidney disease (20% vs. 2%, P = 0.001). There were more diabetics who presented with critical limb ischemia (CLI) (92% vs. 80%, P < 0.001). There was no difference in all-cause mortality over the study period between the two groups (35% vs. 27%, P = 0.11), but diabetics had three times higher major amputation rates (17% vs. 6%, P = 0.001). After adjusting for potential confounders, the risk of amputation was 2.7 times higher in diabetics (hazard ratio [HR] =2.66, 95% confidence interval [CI]: 1.24–5.72, P = 0.001) with no statistically significant difference in loss of primary patency (HR = 1.23, 95% CI: 0.78–1.94, P = 0.37) or primary-assisted patency (HR = 0.98, 95% CI: 0.58–1.64, P = 0.94). CONCLUSIONS: In this study, we found no significant difference in graft patency between diabetic and nondiabetic patients; however, limb loss was almost four folds higher in diabetics with CLI after IBS. This suggests that additional factors after revascularization play an important role in limb salvage in diabetics. Further prospective study in a larger cohort of patients is suggested to evaluate the outcomes of IBS and endovascular therapy in diabetic patients.

Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)

 Article Access Statistics
    PDF Downloaded315    
    Comments [Add]    

Recommend this journal