Contemporary Outcomes of Vein Infra-Inguinal Bypass in Diabetics Patients
Muhammad Rizwan, MD, Satinderjit Locham, MD, Besma Nejim, MD, MPH, Hanaa Aridi, MD, Muhammad Faateh, MD, Thomas Reifsnyder, MD, Mahmoud Malas, MD, MHS.
Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
Objective: Diabetes is a major risk factor for PAD. It is well known that diabetics have different disease progression than non-diabetic patients. In this era of proliferative endovascular therapy, it is important to assess the current outcomes of infra-inguinal bypass surgery (IBS) in the diabetic population. Methods: We identified all patients who underwent IBS at our hospital from 2007-2014. Explanatory analysis using Pearson's Chi Square test and student's t-test were performed. Kaplan-Meier analysis was used to evaluate primary patency (PP), primary assisted patency (PAP) and limb loss. Multivariate cox regression analysis was implemented to examine loss of patency and amputation adjusting for patients demographic, comorbidities and bypass level. Results: A total of 428 IBSs all with veins (264 diabetics, 62%) were performed during the study period. Of these; (32%) were Femoro-Popliteal, (39%) Femoro-Tibial, and (29%) Popliteo-Tibial. Mean follow up time was 2±1.8 years. The diabetics on average were 3 years younger compared to non-diabetics [66.3 (+11.0) vs. 68.9 (+11.9), P=0.03]. Diabetic had significantly higher comorbidities including dyslipidemia (58% vs. 45%, P=0.01), CAD (70% vs. 46%, p <0.01) and CKD on dialysis (20% vs. 2%, <0.001). CLI was more often the presenting diagnosis in diabetic patients 92% vs 80% (P<0.001). The PP and PAP were similar between the two groups (Table). There was no significant difference in the all-cause mortality between the two groups (35% vs 27%, P=0.11). Diabetics had significantly higher amputation rates (17% vs 6% P<0.001). After adjusting for patients' demographics and comorbidities, there was no significant difference in primary [HR (95%CI): 1.24 (0.78-1.94), P=0.36] and primary-assisted patency [HR (95%CI): 0.98 (0.59-1.65), P=0.95]. However, the rate of amputation was almost four folds higher in diabetic patients [(HR (95% CI): 3.70 (1.26-10.90), P=0.02]. Conclusions: Our study found no significant difference in bypass patency, however the rate of amputation is almost four folds higher in diabetic patients after adjusting for potential confounders. This suggests that factors other than revascularization play an important role in limb salvage in diabetics. Further prospective studies in a larger patient cohort is suggested to evaluate the outcomes of IBS and endovascular therapy in diabetic patients.
| Patency | 1 Year % (95% CI) | 2 years % (95% CI) | 3 years % (95% CI) | 4 years % (95% CI) | 5 years % (95% CI) | P | |
| Primary | Diabetics | 70.5 (62.9-76.9) | 60.8 (52.2-68.4) | 59.4 (50.5-67.2) | 54.2 (44.3-63.1) | 54.2 (44.3-63.1) | 0.33 |
| Non-Diabetics | 74.1 (65.0-81.2) | 69.9 (60.0-77.8) | 64.1 (52.7-73.4) | 59.0 (46.3-69.6) | 59.0 (46.3-69.6) | ||
| Primary assisted | Diabetics | 81.5 (74.9-86.4) | 72.6 (64.5-79.1) | 67.3 (58.1-75.0) | 65.5 (55.8-73.6) | 60.1 (45.7-71.7) | 0.39 |
| Non-diabetics | 83.5 (75.5-89.1) | 77.5 (68.2-84.4) | 73.5 (62.8-81.6) | 70.9 (59.1-79.8) | 66.1 (51.2-77.5) |
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