Early outcome of in situ femorotibial reconstruction among patients with diabetes alone versus diabetes and endstage renal failure: Analysis of 83 limbs

Albert Hakaim, J. K. Gordon, T. E. Scott, P. N. Madras, F. B. Pomposelli, J. M. Estes, J. A. Berman, J. L. Cronenwett, R. B. Patterson

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Purpose: Both end-stage renal disease and diabetes have been demonstrated to have a negative effect on the outcome of infrainguinal arterial reconstruction, primarily because of increased perioperative morbidity and wound complications. This study was undertaken to determine whether the combination of these comorbid factors affects the outcome of distal arterial reconstruction. Methods: Eighty-three distal lower extremity arterial bypasses originating from the femoral artery and terminating at the peroneal, anterior, or posterior tibial artery were performed on 76 patients over a 5-year period at a tertiary care medical center. Autogenous greater saphenous vein was used as the bypass conduit in all instances. Combined inflow and composite vein procedures were excluded. Results: There was one perioperative death, for a mortality rate of 1.2%. The diabetes mellitus (DM) plus end-stage renal disease (DM+ESRD) cohort displayed a significantly lower 1-year primary patency rate compared with the diabetes mellitus cohort, 53% versus 82% (p < 0.02). However, the limb salvage rate for the DM+ESRD and DM cohorts during the same time interval were not significantly different, 63% versus 84% (p < 0.06). The 52% 1-year survival rate for the DM+ESRD cohort was strikingly lower than the 90% 1-year survival rate for the DM cohort (p < 0.002). Conclusion: Despite the use of the optimal autogenous conduit, the combination of diabetes and end-stage renal disease can be expected to significantly decrease primary graft patency without affecting limb salvage. The greatest effect of these comorbid factors is on patient survival.

Original languageEnglish (US)
Pages (from-to)1049-1055
Number of pages7
JournalJournal of Vascular Surgery
Volume27
Issue number6
DOIs
StatePublished - 1998
Externally publishedYes

Fingerprint

Renal Insufficiency
Diabetes Mellitus
Extremities
Chronic Kidney Failure
Tibial Arteries
Limb Salvage
Survival Rate
Saphenous Vein
Femoral Artery
Tertiary Care Centers
Lower Extremity
Veins
Morbidity
Transplants
Survival
Mortality
Wounds and Injuries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Early outcome of in situ femorotibial reconstruction among patients with diabetes alone versus diabetes and endstage renal failure : Analysis of 83 limbs. / Hakaim, Albert; Gordon, J. K.; Scott, T. E.; Madras, P. N.; Pomposelli, F. B.; Estes, J. M.; Berman, J. A.; Cronenwett, J. L.; Patterson, R. B.

In: Journal of Vascular Surgery, Vol. 27, No. 6, 1998, p. 1049-1055.

Research output: Contribution to journalArticle

Hakaim, Albert ; Gordon, J. K. ; Scott, T. E. ; Madras, P. N. ; Pomposelli, F. B. ; Estes, J. M. ; Berman, J. A. ; Cronenwett, J. L. ; Patterson, R. B. / Early outcome of in situ femorotibial reconstruction among patients with diabetes alone versus diabetes and endstage renal failure : Analysis of 83 limbs. In: Journal of Vascular Surgery. 1998 ; Vol. 27, No. 6. pp. 1049-1055.
@article{0ad721aa948449439321b94d90ec8136,
title = "Early outcome of in situ femorotibial reconstruction among patients with diabetes alone versus diabetes and endstage renal failure: Analysis of 83 limbs",
abstract = "Purpose: Both end-stage renal disease and diabetes have been demonstrated to have a negative effect on the outcome of infrainguinal arterial reconstruction, primarily because of increased perioperative morbidity and wound complications. This study was undertaken to determine whether the combination of these comorbid factors affects the outcome of distal arterial reconstruction. Methods: Eighty-three distal lower extremity arterial bypasses originating from the femoral artery and terminating at the peroneal, anterior, or posterior tibial artery were performed on 76 patients over a 5-year period at a tertiary care medical center. Autogenous greater saphenous vein was used as the bypass conduit in all instances. Combined inflow and composite vein procedures were excluded. Results: There was one perioperative death, for a mortality rate of 1.2{\%}. The diabetes mellitus (DM) plus end-stage renal disease (DM+ESRD) cohort displayed a significantly lower 1-year primary patency rate compared with the diabetes mellitus cohort, 53{\%} versus 82{\%} (p < 0.02). However, the limb salvage rate for the DM+ESRD and DM cohorts during the same time interval were not significantly different, 63{\%} versus 84{\%} (p < 0.06). The 52{\%} 1-year survival rate for the DM+ESRD cohort was strikingly lower than the 90{\%} 1-year survival rate for the DM cohort (p < 0.002). Conclusion: Despite the use of the optimal autogenous conduit, the combination of diabetes and end-stage renal disease can be expected to significantly decrease primary graft patency without affecting limb salvage. The greatest effect of these comorbid factors is on patient survival.",
author = "Albert Hakaim and Gordon, {J. K.} and Scott, {T. E.} and Madras, {P. N.} and Pomposelli, {F. B.} and Estes, {J. M.} and Berman, {J. A.} and Cronenwett, {J. L.} and Patterson, {R. B.}",
year = "1998",
doi = "10.1016/S0741-5214(98)70008-4",
language = "English (US)",
volume = "27",
pages = "1049--1055",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Early outcome of in situ femorotibial reconstruction among patients with diabetes alone versus diabetes and endstage renal failure

T2 - Analysis of 83 limbs

AU - Hakaim, Albert

AU - Gordon, J. K.

AU - Scott, T. E.

AU - Madras, P. N.

AU - Pomposelli, F. B.

AU - Estes, J. M.

AU - Berman, J. A.

AU - Cronenwett, J. L.

AU - Patterson, R. B.

PY - 1998

Y1 - 1998

N2 - Purpose: Both end-stage renal disease and diabetes have been demonstrated to have a negative effect on the outcome of infrainguinal arterial reconstruction, primarily because of increased perioperative morbidity and wound complications. This study was undertaken to determine whether the combination of these comorbid factors affects the outcome of distal arterial reconstruction. Methods: Eighty-three distal lower extremity arterial bypasses originating from the femoral artery and terminating at the peroneal, anterior, or posterior tibial artery were performed on 76 patients over a 5-year period at a tertiary care medical center. Autogenous greater saphenous vein was used as the bypass conduit in all instances. Combined inflow and composite vein procedures were excluded. Results: There was one perioperative death, for a mortality rate of 1.2%. The diabetes mellitus (DM) plus end-stage renal disease (DM+ESRD) cohort displayed a significantly lower 1-year primary patency rate compared with the diabetes mellitus cohort, 53% versus 82% (p < 0.02). However, the limb salvage rate for the DM+ESRD and DM cohorts during the same time interval were not significantly different, 63% versus 84% (p < 0.06). The 52% 1-year survival rate for the DM+ESRD cohort was strikingly lower than the 90% 1-year survival rate for the DM cohort (p < 0.002). Conclusion: Despite the use of the optimal autogenous conduit, the combination of diabetes and end-stage renal disease can be expected to significantly decrease primary graft patency without affecting limb salvage. The greatest effect of these comorbid factors is on patient survival.

AB - Purpose: Both end-stage renal disease and diabetes have been demonstrated to have a negative effect on the outcome of infrainguinal arterial reconstruction, primarily because of increased perioperative morbidity and wound complications. This study was undertaken to determine whether the combination of these comorbid factors affects the outcome of distal arterial reconstruction. Methods: Eighty-three distal lower extremity arterial bypasses originating from the femoral artery and terminating at the peroneal, anterior, or posterior tibial artery were performed on 76 patients over a 5-year period at a tertiary care medical center. Autogenous greater saphenous vein was used as the bypass conduit in all instances. Combined inflow and composite vein procedures were excluded. Results: There was one perioperative death, for a mortality rate of 1.2%. The diabetes mellitus (DM) plus end-stage renal disease (DM+ESRD) cohort displayed a significantly lower 1-year primary patency rate compared with the diabetes mellitus cohort, 53% versus 82% (p < 0.02). However, the limb salvage rate for the DM+ESRD and DM cohorts during the same time interval were not significantly different, 63% versus 84% (p < 0.06). The 52% 1-year survival rate for the DM+ESRD cohort was strikingly lower than the 90% 1-year survival rate for the DM cohort (p < 0.002). Conclusion: Despite the use of the optimal autogenous conduit, the combination of diabetes and end-stage renal disease can be expected to significantly decrease primary graft patency without affecting limb salvage. The greatest effect of these comorbid factors is on patient survival.

UR - http://www.scopus.com/inward/record.url?scp=0031811290&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031811290&partnerID=8YFLogxK

U2 - 10.1016/S0741-5214(98)70008-4

DO - 10.1016/S0741-5214(98)70008-4

M3 - Article

C2 - 9652467

AN - SCOPUS:0031811290

VL - 27

SP - 1049

EP - 1055

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 6

ER -