Is the revascularisation of pedal arteries worthwhile in diabetic gangrene?

Abstract

The potential of arterial reconstructions at the foot level is a matter of debate. A series of 119 pedal arterial bypass grafts in 114 patients (77 diabetic and 37 non-diabetic patients, mean age 66 years) is reviewed retrospectively, after a mean follow-up 31 months. Of the patients, 91% had foot lesions regarded as Fontaine stage IV, and 97% had occlusions of all crural arteries with patent malleolar or pedal arteries. Autologous vein bypasses were grafted between pedal and either femoral (57%), popliteal (35%), or crural(8%) arteries. Results: the 30-day mortality was 4.4%, and the total mortality after 31 months was 21%. Postoperative graft failure resulted in 22 amputations above the ankle (in 12% of the diabetic, and in 32% of the nondiabetic patients). The one-year primary (secondary) graft patency rates were 67% (69%) in the diabetic patients, and 51% (59%) in the nondiabetic patients. Limb salvage rate was 82% (D) versus 62% (ND) after 1 year, and 64% (D) versus 55% (ND) after 31 months. Conclusion: nearly two thirds of diabetic patients with partial foot gangrene will benefit from timely pedal arterial reconstruction, and more than half of nondiabetic patients.