Purpose: The prevalence of chronic critical limb ischemia has been increased significantly due to the increased incidence of atherosclerosis obliterans in Korea. Higher rates of lower extremity amputation, along with increased incidence and severity of coronary artery disease are well recognized in diabetic patients and may discourage any aggressive treatment in these patients. To determine the role of diabetes mellitus(DM) in graft outcome of peripheral arterial occlusive disease in our patient population, diabetic patients who underwent bypass were reviewed.
Method: Thirty-two patients who underwent 37 arterial bypass grafts (operated group) and 42 patients who were admitted to our center for arterial occlusive disease (non-operated group) from March 1999 to December 2002 were reviewed retrospectively. The operated group was divided into two subgroups: DM (15 bypasses) and non-DM (22 bypasses). Primary patency rates of arterial bypass graft and postoperative ankle brachial index were compared.
Result: Most patients were males (93.7% in operated group, 90.4% in non-operated group), and peak incidence was in the seventh decade. The risk factors were male sex (90.5%), smoking history (58.2%), hypertension (39%), DM (37.8%) and old age (＞70 years, 27%). Primary cumulative graft patency rates at 2 months were 93.9% and 95.2% in DM and non-DM patients, respectively. Primary cumulative graft patency rates at 2 years were 70.2% and 71.2% in DM and non-DM patients, respectively, and there was no statistical difference between the two groups.
Conclusion: Arterial bypass grafting for peripheral arterial occlusive disease can be performed successfully in diabetic patients with a comparable patency rate to those without DM, and more a aggressive approach including bypass grafting should be undertaken to achieve limb salvage in the diabetic population for their improved quality of life.
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