Short and long-term outcomes of the peripheral arterial indirect bypass in diabetic patients with chronic limb-threatening ischemia: Single-center case series

Abstract

ObjectivePeripheral arterial disease (PAD) is the main cause behind non-healing painful foot ulcers, disabilities and amputation diabetic patients. Diabetes Milletus (DM) negatively affects long-term patency and limb salvage operations. Peripheral indirect femoropopliteal bypass is one of the most common method of revascularization for diabetic patients with critical limb ischemia. Our study shows short and long-term outcomes of infra-inguinal indirect bypasses in diabetic patients. We evaluated the QoL of our series of patients after bypass surgery. MethodsProspective observational single center study with retrospective analysis of the data conducted over 13 years from February 2007 to February 2020. A total of 150 diabetic patients with features of CLTI of the lower limbs were admitted for revascularization. All patients underwent infra-inguinal indirect (non-Angiosome) bypass using autologous great saphenous vein graft only. ResultsA total of 150 type 2 diabetic patients included; 107 male (71.3%) and 43 female (28.7%). Age ranged from 42 to 77 years with a mean of 61.77(±6.83) years. The commonest presentation was major tissue loss (category 6) in 45.3% of the cases, rest pain (category 4) was present in 28.6% of the cases followed by minor tissue loss in another 28% of the cases, while only 26% of the cases had minor tissue loss (category 5).The three most common types of bypasses were femoro-popliteal infra-genicular (FMPOP-IG) (56%), femoro-popliteal retro-genicular (RG) (25.3%) and femoro-posterior tibial (F-PT) (10%).Preoperative quality of life (QoL) measured by VASCUQoL-6, Most of the patients (61.9%) had VASCUQoL-6 of 4 and 5. At 3 months the maximum VASCUQOL-6 remained at 11 while at 36 months, the minimum VASCUQoL-6 was 17.8 and maximum reached 20. ConclusionIt is necessary to have the possibility of performing open indirect bypass revascularization for diabetic patients with CLTI, even in the absence of possibility for endovascular therapies.