The management and outcome of critical limb ischaemia in diabetic patients: results of a national survey. Audit Committee of the Vascular Surgical Society of Great Britain and Ireland.

Abstract

It is generally considered that the outcome from critical limb ischaemia (CLI) in people with diabetes is inferior to that in non-diabetic patients. However, excellent results have been reported in diabetic people with the use of bypass surgery to pedal arteries. Data from a prospective national survey on CLI have been analysed to compare surgical practice and outcome from CLI in diabetic and non-diabetic populations. Of 679 limbs included in the survey, 204 (30%) were in diabetic patients. Thirty-seven (18%) of diabetic limbs were treated by primary amputation compared to 43 (9%) in non-diabetics (p = 0.0013). Revascularization was the primary treatment intention in 127 (62.3%) of diabetic limbs compared to 342 (72%) in non-diabetics (p = 0.01). Bypass to pedal arteries was reported in only 2 (1%) diabetic patients. The limb salvage rate in diabetic patients was 60%, compared to 72.5% for non-diabetic patients (p = 0.0013). The mortality rates were 15% and 12% in diabetic and non-diabetic patients, respectively (NS). These results confirm that in the UK and Ireland diabetic patients with CLI fare considerably worse than do people without diabetes. The results may be improved if more pedal artery reconstructions were performed.