Surgical Vascular By-pass Operation of Lower Limb Artery Occlusion in Patients with Diabetic Foot

Abstract

To document the effectiveness and patient experience of surgical treatment for diabetic lower limb arterial occlusion. Methods Out of 290 diabetic patients with lower limb arterial occlusion, 69 received by-pass operation because of severe stenosis below the abdominal aorta and severe ulcers in feet from April 2004 to April 2011. We reviewed the experience and outcome of the 69 diabetic patients who underwent surgical operations on lower limb arterial occlusion. Results 100% initial surgical success was achieved. The morbidity (excluding death) was 12.3%±4.1% and 15.7%±5.1% at 1 year and 3 years after operations, respectively. Five (7.2%) death cases were recorded, which resulted in a survival rate of 94.2%±2.8% and 92.0%±3.5% at 1 year and 3 years after operations, respectively. About 90.6%±3.6% and 87.2%±4.9% of patients had graft patency 1 year and 3 years after operations, respectively; and 6.5%±3.1% had amputations. Four (5.8%) patients developed graft thrombosis, in which 2 (2.9%) had amputations because of recurrence of thrombosis after thrombectomy. Two (2.9%) patients had amputations because of graft infection accompanied with graft resection operations. One (1.4%) patient received repeated arterialized operation on great saphenous vein because of popliteal artery occlusion, and obtained a good outcome within two years. One (1.4%) patient developed stomas false aneurysm, but the excision of the false aneurysm resulted in a good outcome in four years. Conclusion Detailed pre-operation assessment, optimal selection of surgical procedure and perioperative management can help improve the outcome of diabetes and decrease amputation rate in patients with diabetic lower limb arterial occlusion.

Keywords: Diabetes mellitus, Diabetic foot, Lower extremities artery disease, Vascular by-pass operation, Complication, Therapeutic effect