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

ABSTRACT

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.