medigraphic.com
Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado

2008, Number 3

<< Back Next >>

Rev Esp Med Quir 2008; 13 (3)

Lower extremity rescue in diabetic patients with critical ischemia. Five years experience

Pérez HJ, Hernández LD, Revilla CH, Palacio VF

Language: Spanish
References: 18
Page: 121-125
PDF size: 224.69 Kb.


ABSTRACT

Objective: To know the experience of lower extremities rescue in diabetic patients. It compares the results of our hospital and similar reports.
Material and methods: There were included 163 diabetic patients with critical ischemia of the lower extremities. In all of them there were made arterial femoropoplitean and femorotibial bypass with reversed venous graft and PTFe, from 2000 to 2005 in the Regional Hospital General Ignacio Zaragoza; the underwent of the graft permeability was done by physical examination and linear Doppler (subjective measurement of arterial flow).
Results: Expandable politetrafluorethilen graft was applied in 135 patients (82.8%) and autologous reversed saphenous vein graft was applied in 28 patients (17%). Femoropopliteal graft was made in 139 patients (85.2%) and femorotibial posterior graft in 24 patients (14.7%). Seven patients had infection of PTFe (4.2%). Complete amputations with reversed bypass were made in four patients (14.2%), and incomplete amputations in seven patients (25%). In the patients with PTFe, 14 complete amputation (11.5%) and 15 partial amputation (11.1%) were made.
Conclusions: Diabetic patients with critical ischemia are candidates to revascularization. The choice procedure between the reversed graft and PTFe bypass is still not defined. In our study, the PTFe graft was superior to the venous graft, with 87 and 85.7%, respectively.


REFERENCES

  1. Rutherford RB, et al (eds). Vascular Surgery. 5th ed. Philadelphia: BW Saunders, 2000, Vol. 1.

  2. Dean RH. Diagnóstico y tratamiento en cirugía vascular. México, DF: El Manual Moderno, 2000.

  3. Smith GD, Shipley MJ, Rose G. Intermittent claudication, heart disease risk factors, and mortality. The Whitehall Study. Circulation 1990;82:1925-31.

  4. Estevan JM. Epidemiología de las isquemias agudas. En: Vaqueiro MF (ed). Isquemias agudas. Barcelona: Lab Uriach 1994;pp:44-48.

  5. Esses GE, Dennis FB. Diagnóstico y tratamiento en cirugía vascular. México: El Manual Moderno, 1997;p:8.

  6. Jackson MR, Belott TP, Dickason T, Kaiser WJ, et al. The consequences of a failed femoropopliteal bypass grafting: Comparison of saphenous vein and PTF grafts. J Vasc Surg 2000;32(3):498-504, 504-5.

  7. LoGerfo FW, Coffman JD. Current concepts. Vascular and microvascular disease of the foot in diabetes. Implications for foot care. N Engl J Med 1984;311(25):1615-9.

  8. Klinkert P, Schepers A, Burger DH, van Bockel JH, Breslau PJ. Vein versus polytetrafluoroethylene in above-knee femoropopliteal bypass grafting: Five-year results of a randomized controlled trial. J Vasc Surg 2003;37(1):149-55.

  9. Mc Dermott MMc, Carthy W. Claudicación intermitente. En: Gewertz BL, Arteriopatía oclusiva de miembros inferiores Clínicas Quirúrgicas de Norteamérica. 1995;4:148.

  10. Sahi D, Eliasson B. Assessment of the toe blood pressure is an effective screening method to identify diabetes patients with lower extremity arterial disease. Angiology 2004;55:641-51.

  11. Lavery L, et al. Advances in managing the diabetic foot. University of Virginia Health System. November 2000:59-69.

  12. Izumi Y, Satterfield K, Lee S, Harkless LB. Risk of reamputation in diabetic patients stratified by limb and level of amputation: A 10-year observation. Diabetes Care 2006;29:566-70.

  13. Smith GR, Green RM. Pseudooclusion of femoropopliteal bypass grafts. Circulation 1993;68(Suppl II):88-93.

  14. Albers M, Romiti M, Brochado-Neto FC, Pereira CA. Meta-analysis of alternate autologous vein bypass grafts to infrapopliteal arteries. J Vasc Surg 2005;42(3):449-55.

  15. Criqui MH, Langer RD, Fronek A, Feigelson HS, et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 1992;326(6):381-6.

  16. Green RM, Ouriel K, Ricotta JJ, De Weese JA. Revision of failed infrainguinal bypass graft: Principles of management. Surgery 1986;100(4):646-53.

  17. Sheahan MG, Hamdan AD, Veraldi JR, McArthur CS, et al. Lower extremity minor amputations: The roles of diabetes and timing of revascularization. J Vasc Surg 2005;42(3)476-80.

  18. Bloor K. Natural history of arteriosclerosis of the lower extremities. Ann R Coll Surg Engl 1998;28:36-53.




2020     |     www.medigraphic.com