Revascularisation in diabetic "small vessel disease" of lower limbs: is it worthwhile?

BACKGROUND: Diabetic patients with critical ischaemia of the lower limb despite a palpable popliteal pulse are presumed to have 'small vessel disease' that is unreconstructable and often subjected to major amputation. Results of revascularisation in such patients are presented. METHODS: A prospective observational study of revascularisation [n = 23, 14 men, mean age 62 years (range 47 to 80)] using saphenous vein to bypass occluded infrapopliteal arteries in diabetics with critical leg ischaemia over a 5-year period. OUTCOME MEASURES: Surgical mortality, graft patency, major amputation rate, time taken for healing, ambulation after discharge from hospital. RESULTS: There was one death within 30 days of surgery. 2/4 early thromboses were salvaged, 5 (5/22) limbs were amputated. Limb salvage was 17/23 (74%). Two limbs were amputated because of thrombosis and 3 were amputated for spreading sepsis despite a patent graft. 2 late graft failures were detected but the limbs remain healed and functional. 15/23 (65%) re-vascularisations remained patent at a mean follow up of 30 months (range 4 to 60). Mean wound healing time was 30 days (range 16 to 45). 14/17 (82%) of those with salvaged limbs were independent with regard to ambulation. CONCLUSION: Bypass of diabetic small vessel disease of the lower limbs is feasible and effective in preventing major amputation and maintaining independent mobility.

The swollen leg: is it deep vein thrombosis? The experience of a tertiary referral center in Sri Lanka.

INTRODUCTION: The role played by deep vein thrombosis (DVT) as a cause of leg swelling in Sri Lanka is unknown. PURPOSE: To study the prevalence of proximal DVT, value of risk factors and clinical features and attitudes of clinicians towards diagnosis and treatment of DVT among those presenting with leg swelling as the main complaint. DESIGN: Prospective consecutive referrals to the University Surgical Unit, Colombo, over 10 months starting in January 1998. INCLUSION CRITERIA: DVT suspects with swollen legs. EXCLUSION CRITERIA: Varicose veins, leg ulceration and generalized oedema. METHODS: Color duplex scanning of the proximal deep veins and the superficial veins to detect occlusion and reflux. Information on previous diagnoses and treatment were obtained from the medical records. RESULTS: 63/137 (45%) had deep venous causes for oedema. Fever with rigors and inguinal lymphaedenopathy were strongly predictive of non DVT causes. Filariasis is the first diagnosis and DVT is considered late among the outpatients. CONCLUSIONS: DVT is a common cause of leg swelling among those referred.