Comparison of Graft Patency Rates between the Diabetic and Non-diabetic Patients after Infrainguinal Arterial Bypasses

Lee, Ji Whan; Kim, Sang Geol; Huh, Seung; Kim, Young Wook

Abstract

PURPOSE: It is well known that leg amputaions are more common in diabetic than non-diabetic patients with arterial occlusive disease. However, the previous reports comparing the graft patencies following infrainguinal bypasses between diabetic and non-diabetic patients revealed a wide range of variance. We tried to determine whether there is a difference on the graft patency between diabetic and non-diabetic patients with infrainguinal arterial bypasses. METHOD: During the period from March, 1993 to December, 1999, 271 infrainguinal bypass grafts were implanted to the limbs with chronic atherosclerotic arterial occlusive disease at Kyungpook National University Hospital, Taegu, Korea. Among them, 193 limbs with autogenous reversed vein grafts were included in this study, which comprised of 65 limbs (34%) in diabetic and 128 limbs (66%) in non-diabetic patients. To compare the graft patencies between diabetic and non-diabetic patients, we divided them into 3 groups according to the levels of distal anastomosis. We used life table or Kaplan-Meier methods to calculate the cumulative primary patency rates and log-rank test to compare the graft patencies between the groups. RESULT: The sites of distal anastomosis were above-knee popliteal artery in 29.2%, below-knee popliteal artery in 40.0%, and infrapopliteal artery in 30.8% of diabetic patients, whereas above-knee popliteal artery in 21.1%, below-knee popliteal artery in 50.0%, and infrapopliteal artery in 28.9% of non-diabetic patients. Vein grafts used in the bypasses were 185 reversed greater saphenous veins, 5 spliced veins, and 3 arm veins. The cumulative primary patency rates at 1, 3 and 5 years were 86% (SE 5.0%), 74% (SE 7.6%) and 74% (SE 7.6%) respectively, in diabetic patients, while 84% (SE 3.7%), 73% (SE 5.2%) and 56% (SE 9.8%) respectively, in non-diabetic patients group. After comparing the patency rates between 2 groups at 3 different levels of distal anastomosis, there was no statistically significant (p<0.05) difference at any level. CONCLLUSION: We found that diabetes did not affect the primary graft patency following the lower extremity arterial bypasses using reversed vein grafts.