Abstract
Background: The underlying cause for severe ischaemic foot lesions in diabetics is not infrequently a specific occlusion pattern exclusively involving infrapopliteal arteries. To attain limb salvage in this setting, since the early eighties short vein grafts originating from infragenicular arteries (distal-origin bypasses) were used to bypass the occluded crural vessels. This presentation describes our 15-year experience with this strategy and, in addition, assesses the outcome in patients suffering from end stage renal disease (ESRD). Patients and methods: Since May 1986, 135 diabetic patients underwent 143 so-called "distal-origin bypasses" in the presence of extended infrapopliteal arterial occlusions and critical foot ischaemia (rest pain 3, tissue loss 140). The mean age in this group was 70,1 years. 43 patients had impaired renal function including 16 cases with ESRD. Results: The 30 day mortality in our series was 2.1%. During the follow-up a total of 82 patients died, mainly from cardiovascular causes. Using life-table analysis, primary and secondary patency rates for these bypasses with distal graft origination were 90% and 97% at 30 days, 76% and 83% at 1 year and 46% and 51% at 7 years, respectively. The corresponding limb salvage rates for the whole group amounted to 94%, 80% and 64%. Comparing patients having normal or slightly impaired renal function with those diagnosed of ESRD, a significantly different result with higher limb salvage rates in favour of the first patient subgroup was noted after 5 years (77% vs. 39%; p = 0.0023). Conclusion: In our series, the importance of short vein grafts to avoid limb loss in diabetic patients with infrapopliteal artery occlusions and critical foot ischaemia has been well established. Despite poorer limb salvage rates achieved in ESRD-patients, our results suggest, that even these high risk patients should not be denied arterial reconstruction.
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