Journal «Angiology and Vascular Surgery» • 

2010 • VOLUME 16 • №1

LONG-TERM OUTCOMES OF AORTOFEMORAL RECONSTRUCTIONS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Pokrovsky A.V., Doguzhieva R.M, Bogatov Yu.P., Goltsova E.E., Lebedeva A.N.
Department of Vascular Surgery, Federal State Facility A.V. Vishnevsky Institute of Surgery under the Russian Federal Agency on High-Technology Medical Care,
Moscow, Russia

Studied herein are long-term outcomes of aortofemoral reconstructions in a total of 469 patients presenting with atherosclerosis. Of these, 201 (42.8%) patients were diagnosed as suffered from type 2 diabetes mellitus (DM). By the time of the survey, the age of the patients in this group averaged 64.7±1.2 years. The remaining 268 (57.2%) patients (mean age 62.5±1.7 years) turned out to be non-diabetic.

Surgical interventions performed on the background of pronounced limb ischaemia (50% of the patients had critical ischaemia) had made it possible to save the limb affected and for a long time to increase the distance of pain-free walk in 85.9% of diabetic patients and in 93.1% of non-diabetic subjects. Nine years after the vascular reconstruction of the aortoiliac zone, the indices of the cumulative patency of the bypass grafts (72% for diabetic patients and 81% for non-diabetics) and the limb-salvage rate (78.9% for those with DM and 88.5% for those without DM) remained sufficiently high.

The cumulative survival rate amongst the diabetic patients after 3 and 6 years was significantly lower (74.0% and 58.0%, respectively) as compared with that in the non-diabetic patients (93.0% and 72.0%), P<0.01, whereas by the 9-year period of follow-up it turned out to be similarly low in the both groups of patients (amounting to 26.0% and 29.0%, respectively).In diabetic patients, the mortality rate was significantly higher, with deaths occurring earlier, than in those from the comparison group (43.1% at 56.0±2.4 months and 28.9% at 62.4±1.9 months, respectively). The underlying causes of death regardless ofthe presence of diabetes mellitus chiefly comprised cardiac complications which in diabetic patients were observed significantly more often and occurring at earlier terms (52.9% at 49.5±1.7 monthsand 31.1% at 62.1±1.5 months, respectively, P=0.04). Hence, despite the presence of DM, aortofemoral reconstructions in the majority of cases (up to 80%) make it possible to reliably and for a long time prevent the development of critical ischaemia and to save the lower limbs.

KEY WORDS: diabetes mellitus, aortofemoral bypass grafting, clinical effect, survival rate, graft patency, limb salvage.

P. 53

« Back

Angiologia.ru - portal for professionals
VLAANT
Lancet
HI-TECHNOLOGY MEDICINE