Journal «Angiology and Vascular Surgery» • 

2010 • VOLUME 16 • №1


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.

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