INSITU SAPHENOUS-VEIN BYPASS-SURGERY IN DIABETIC-PATIENTS

From 1986 through to 1990 a total of 483 consecutive in situ infra-inguinal vein bypass procedures were performed in 444 patients, of whom 112 (25%) were diabetics (57 insulin dependent diabetes mellitus and 55 non-insulin dependent diabetes mellitus). Based on a prospective vascular data registry this material was analysed to determine the influence of diabetes on the outcome. Preoperative risk factors were equally distributed among diabetic and non-diabetic patients, except for smoking habits (diabetics: 48%; non-diabetics: 64%, p = 0.002) and cardiac disease (diabetics: 45%; non-diabetics: 29%, p = 0.005). Indication for surgery was gangrene or ulceration in 57% of diabetics, as opposed to 36% in non-diabetic patients (p = 0.0002). A femoro-popliteal by pass was performed in 18% of patients, whereas 82% received an infrapopliteal procedure, of which 42% were to the distal third of the calf or foot. Diabetic patients had a significantly lower distal anastomosis than non-diabetic patients (p = 0.0001). The overall 3-year primary and secondary patency rates were 58 and 64%, respectively, with no differences between non-diabetics, non-insulin-dependent diabetics and insulin-dependent diabetics. Neither did limb survival differ among the three groups. However, the rate of minor amputations was significantly higher in insulin-dependent compared with non-insulin-dependent diabetics, who in turn had a higher rate than non-diabetic patients (p < 0.00001). A markedly decreased survival rate was found in diabetics (p < 0.0005). We found the in situ bypass technique very useful in the treatment of critical ischaemia of the lower limb in diabetic patients, who often need a distal anastomosis to a single calf or foot vessel. The overall results in diabetic patients, whether insulin-dependent or not, were equal to those in non-diabetic patients.