Non-insulin Dependent Diabetes Mellitus Is Associated With Poor One Year Primary Patency And Primary Assisted Patency For Aortobifemoral Bypasses
Marcos Takuya Kuroki, MD-PhD, Faisal Aziz, MD, Maria Camila Castello Ramirez, MD.
Penn State College of Medicine, Hershey, PA, USA.
OBJECTIVES: Several studies have shown that diabetes is a risk factor for reduced long-term survival following open aortic reconstruction for aortoiliac occlusive disease (AIOD). However, the reported effect of diabetes on the patency of bypass grafts for AIOD has been mixed. It has been shown that the impact of diabetes on postoperative outcomes vary according to the type of diabetes (noninsulin dependent vs insulin dependent). We sought to determine the effect of diabetes on graft patency and limb salvage rate following aortobifemoral bypass for AIOD.
METHODS: This was a retrospective cohort study of patients who underwent ABFB for AIOD from 2009 to 2019 in the Society of Vascular Surgery Vascular Quality Initiative (VQI) suprainguinal bypass database. The effect of diabetes, stratified between non-insulin dependent (NIDDM) and insulin dependent diabetes (IDDM), on one-year primary, primary-assisted, and secondary patency, as well as amputation free survival, was tested using Cox proportional hazards regression, and compared to non-diabetics using the log-rank test.
RESULTS: 2595 patients who underwent ABFB met inclusion criteria. The median follow-up time was 369 days. Of those, 2071 were non-diabetic (80%), 310 (12%) had NIDDM, and 213 (8%) had IDDM. On univariate analysis, diabetes had a statistically significant effect on one-year primary and primary-assisted patency, and amputation-free survival. However, there was no effect of diabetes on secondary patency. On multivariate analysis, after accounting for group differences in indication, urgency, age, gender, BMI, and pre-operative comorbidities, NIDDM was associated with reduced one-year primary patency (87%, hazard ratio 1.94, 95% CI 1.23-3.04; p = 0.004), and primary-assisted patency (91%, hazard ratio 2.14, 95% CI 1.28-3.57; p = 0.004) compared to non-diabetics (93%, and 96%, respectively). IDDM had no statistically significant effect on one-year patency outcomes or amputation free survival compared to non-diabetics.
CONCLUSIONS: Diabetes is a significant risk factor for reduced primary and primary assisted patency following ABFB for AIOD. Among diabetics, NIDDM, but not IDDM, was associated with reduced primary and primary-assisted graft patency. This result suggests that there may be potentially modifiable risk factors for improved short term patency outcomes among diabetics undergoing ABFB for AIOD.
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