Diabetic revascularization: improving limb salvage in the absence of autogenous vein.

Abstract

Summary Diabetic patients can be offered opportunities for lower extremity revascularization with the expectation of results equal to those in the nondiabetic population. For those diabetics in danger of limb loss without adequate saphenous vein, alternatives exist for distal bypass resulting in acceptable long-term patency and limb salvage. As the population ages and approaches toward limb salvage become more aggressive, vascular surgeons will require alternative conduits to autogenous saphenous vein in a certain subset of patients. A PTFE graft with a distal vein patch may prove an acceptable alternative in the absence of saphenous vein. A multicenter prospective randomized trial may be of benefit to address the question of the best alternative for the patient without suitable autogenous saphenous vein for limb salvage. Until then, we will offer the patient without adequate vein PTFE bypasses to tibial arteries for limb salvage with the addition of a distal vein patch.