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Annals of Vascular Surgery

, Volume 17, Issue 6, pp 670–675 | Cite as

Outcomes following Distal Bypass Graft Occlusion in Diabetics

  • Boulos ToursarkissianEmail author
  • Paula K. Shireman
  • John Schoolfield
  • Ronald L. Blumoff
Papers Presented at the Thirteenth Annual Winter Meeting of the Peripheral Vascular Surgery Society

Abstract

The objectives of this study were to define clinical outcomes following distal bypass graft occlusion in diabetic patients and identify factors predictive of limb loss. A retrospective review was conducted of all distal graft occlusions over a 5-year period in diabetic patients. Popliteal grafts, perioperative (30 days) failures, and redo distal bypasses were excluded. Eighty grafts were studied (43 cases done for ulcers, 31 for gangrene, and 6 for rest pain). Time to occlusion averaged 13 ± 17 months post-bypass (median 6 months). Interventions following graft occlusion (lysis, thrombectomy, revision, or new bypass) were carried out in only 26 cases, leading to limb salvage in 11 cases (42%). This compares to a limb salvage rate of 54% in the 54 cases where no intervention was done (p = NS). The overall amputation rate was 50% (14 AKAs and 26 BKAs). The interval between graft occlusion and amputation averaged 2 ± 2 months. Limbs saved were followed an average of 14 ± 11 months after graft occlusion. The presence of a foot wound (new or old) was associated with a higher likelihood of amputation (67% vs. 32% for cases with no foot wounds at the time of bypass failure; p < 0.005). In cases requiring an amputation, the toebrachial index averaged 0 ± 0 post-bypass failure vs. 0.2 ± 0.2 in cases where limbs were saved (p < 0.05). Patients with congestive heart failure or who were nonambulatory at the time of graft occlusion were more likely to end up with an amputation (p < 0.05). Limb loss was also more likely when gangrene had been the initial operative indication. No other factors were predictive of limb loss, including vein configuration, inflow or outflow level, prior bypass revision, known graft stenosis, time to occlusion, age, gender, other medical conditions, pre- or post-bypass ABI or TBI, graft velocities, or use of anticoagulants. Limb loss following primary distal bypass failure in diabetics is high. Repeat interventions have limited success. The findings justify aggressive programs of graft maintenance, and vigorous attempts at early closure of foot wounds.

Keywords

Limb Salvage Popliteal Artery Graft Occlusion Amputation Rate Limb Loss 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Jackson, MR, Belott, TP, Dickason, T,  et al. 2000The consequence of a failed femoropopliteal bypass grafting: comparison of saphenous vein and PTFE grafts.J Vasc Surg32498505CrossRefPubMedGoogle Scholar
  2. 2.
    Toursarkissian, B, D’Ayala, M, Stefanidis, D,  et al. 2002Angiographic scoring of vascular occlusive disease in the diabetic foot: relevance to bypass graft patency and limb salvage.J Vasc Surg35494500CrossRefPubMedGoogle Scholar
  3. 3.
    Rutherford, RB, Baker, JD, Ernst, C,  et al. 1997Recommended standards for reports dealing with lower extremity ischemia: revised version.J Vasc Surg26517538PubMedGoogle Scholar
  4. 4.
    Rhodes, JM, Gloviczki, P, Bower, TC,  et al. 1999The benefits of secondary interventions in patients with failing or failed pedal bypass grafts.Am J Surg178151155CrossRefPubMedGoogle Scholar
  5. 5.
    Jackson, MR, Johnson, WC, Williford, WO,  et al. 2002The effect of anticoagulation therapy and graft selection on the ischemic consequences of femoropopliteal bypass graft occlusion: results from a multicenter randomized clinical trial.J Vasc Surg35292298CrossRefPubMedGoogle Scholar
  6. 6.
    Henke, PK, Procotr, MC, Zajkowski, PJ,  et al. 2002Tissue loss, early primary graft occlusion female gender, and a prohibitive failure rate of secondary infrainginal arterial reconstruction.J Vasc Surg35902909CrossRefPubMedGoogle Scholar
  7. 7.
    Toursarkissian, B, Dayala, M, Shireman, PK,  et al. 2001Lower extremity bypass graft revision in diabetics.Vasc Surg35369378PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Boulos Toursarkissian
    • 1
    Email author
  • Paula K. Shireman
    • 1
  • John Schoolfield
    • 1
  • Ronald L. Blumoff
    • 1
  1. 1.Division of Vascular SurgeryUniversity of Texas Health Science Center at San Antonio, San Antonio, TexasUSA

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