Cal y Mayor I, Serrano LJ, Cossío ZA, Sánchez NN, Rodríguez AE, Huerta HH, González HR, Anaya AB, Cisneros TMA

Language: Spanish
References: 29
Page: 18-22
PDF size: 69.24 Kb.

ABSTRACT

Background: Due to the characteristics of the arterial damage in the diabetic patients, where the tib-ial arteries are predominantly involved, the arterial revascularization procedures are a favored procedure in the treatment of diabetic patients with critical ischemia.
Methods: We performed a retrospective and descriptive study to verify the limb salvage percent and to analyze the variables that may contribute as risk factor for limb loss.
Results: We recovered data from 67 diabetic patients with critical ischemia to whom 70 revascularization procedures for limb salvage were performed from January 1999 to June 2004 in the Hospital Lic. Adolfo López Mateos, (median age 70 years old, 64.2% male). The analyzed variables were: duration of diabetes, type of treatment, smoking habit, other comorbidities, the surgical indication, the inflow and outflow vessel and the type of graft. From the follow up period (mean 7.8 months) we recorded the complications, mortality and amputations. Limb salvage was achieved in 58.6%. The primary patency rate for the first three months was 78.2% and 46% after one year. The only variable associated significantly with a higher risk for limb loss was the need to perform the limb salvage procedure due to gangrene (p = 0.002).
Conclusion: Limb salvage in the diabetic patient is a challenge that continues on after the revascularization is performed. The patients require a preoperative preparation and study, the prompt and adequate treatment of complications, and the need for a careful follow up to verify the permeability of the graft.

REFERENCES

1. Martínez F y cols. Pie diabético, epidemiología, implicaciones quirúrgicas y su costo. Cirujano General 1991; 13: 289-90.

2. Ruderman NB, Haudenschild C. Diabetes as an atherogen-ic factor. Prog Cardiovasc Dis 1984; 26: 373-412.

3. Stokes J, Kannel WB, Wolf PA, Cupples LA, D’Agostino RB. The relative importance of selected risk factors for var-ious manifestations of cardiovascular disease among men and women from 35 to 64 years old: 30 years of follow-up in the Framingham Study. Circulation 1987; 75: 65-73.

4. Akbari CM, LoGerfo FW. Diabetes and peripheral vascular disease. J Vasc Surg 1999; 30: 373-84.

5. Brand FN, Abbott RD, Kannel WB. Diabetes, intermittent claudication, and risk of cardiovascular events. The Framingham Study. Diabetes 1989; 38: 504-9.

6. Menzoian JO, LaMorte WW, Paniszyn CC, et al. Symptomatology and anatomic patterns of peripheral vascular dis-ease: differing impact of smoking and diabetes. Ann Vasc Surg 1989; 3: 224-8.

7. Faries PL, LoGerfo FW, Hook SC, Pulling MC, Akbari CM, Campbell DR, Pomposelli FB JR. The impact of diabetes on arterial reconstructions for multilevel arterial occlusive. Am J Surg 2001; 181(3): 251-5.

8. Rivers SP, Scher L, Veith FJ. Indications for distal arterial reconstruction in the presence of palpable pedal pulses. J Vasc Surg 1990; 12: 552-7.

9. Ascer E, Veith FJ, Gupta SK. Bypasses to plantar arteries and other tibial branches: An extended approach to limb salvage. J Vasc Surg 1988; 8: 434-41.

10. DePalma RG, Talien YJ. Infrainguinal reconstruction in diabetes. Diabetes 1996; 45(Suppl. 3): S126-S128.

11. Misare BD, Pomposelli FB Jr., Gibbons GW, Campbell DR, Freeman DV, LoGerfo FW. Infrapopliteal bypasses to severely calcified, unclampable outflow arteries: Two-year results. J Vasc Surg 1996; 24: 6-16.

12. Akbari CM, Pomposelli FB Jr, Gibbons GW, Campbell DR, Pulling MC, Mydlarz D, LoGerfo FW. Lower Extremity Revascularization in Diabetes: Late Observations. Arch Surg 2000; 135: 452-6.

13. Ciervo A, Dardik H, Qin F, Silvestri F, Wolodiger F, Hastings B, Lee S, Pangilinan A, Wengerter K. The tourniquet revisited as an adjunct to lower limb revascularization. J Vasc Surg 2000; 31(3): 436-42.

14. Pomposelli FB Jr., Marcaccio EJ, Gibbons GW, Campbell DR, Freeman DV, Burgess AM, Miller A, MB, LoGerfo FW. Dorsalis pedis arterial bypass: Durable limb salvage for foot ischemia in patients with diabetes mellitus. J Vasc Surg 1995; 21: 375-84.

15. Tannenbaum GA, Pomposelli FB Jr., Marcaccio EJ, Gibbons GW, Campbell DR, Freeman DV, Mille A, LoGerfo FW. Safety of vein bypass grafting to the dorsal pedal artery in diabetic patients with foot infections. J Vasc Surg 1992; 15: 982-90.

16. Pomposelli FB, Kansal N, Hamdan AD, Belfield A, Sheahan M, Campbell DR, Skillman JJ, Logerfo FW. A decade of experience with dorsalis pedis artery bypass: Analysis of outcome in more than 1000 cases. J Vasc Surg 2003; 37: 307-15.

17. Rodríguez Trejo JM, Escotto Sánchez I, Rodríguez Ramírez N. Enfermedad arterial periférica obliterante e insuficiencia arterial en el diabético. Rev Mex Angiol 2004; 32: 84-92.

18. Watkins PJ. The diabetic foot. BMJ 2003; 326: 977-9.

19. Treiman GS, Oderich GSC, Ashrafi A, Peter A, Schneider PA. Management of ischemic heel ulceration and gangrene: An evaluation of factors associated with successful healing. J Vasc Surg 2000; 31: 1110-8.

20. Reifsnyder T, Grossman JP, Leers SA. Limb loss after low-er extremity bypass. Am J Surg 1997; 174(2): 149-51.

21. Toursarkissian B, D’Ayala M, Shireman PK, Schoolfield J, Sykes MT. Lower extremity bypass graft revision in diabetics. Vasc Surg 2001; 35(5): 369-77.

22. Hakaim AG, Gordon JK, Scott TE. Early outcome of in situ femorotibial reconstruction among patients with diabetes alone versus diabetes and end-stage renal failure: Analysis of 83 limbs. J Vasc Surg 1998; 27(6):1049-55.

23. Brothers TE, Robison JG, Elliott BM. Diabetes mellitus is the major risk factor for African Americans who undergo peripheral bypass graft operation. J Vasc Surg 1999; 29(2): 352-9.

24. Rodriguez Trejo JM. Derivación femoropoplítea en el adulto mayor, ¿es el politetrafluoroetileno una prótesis aceptable? Rev Mex Angiol 2001; 29(2): 43-9.

25. Rojas Reyna, Cervantes Castro, Rodríguez Torres, Flores Carlos. Revascularización arterial distal en el diabético. Rev Mex Angiol 1998; 26: 22-6.

26. García-Girón G, Serrano-Lozano J, Cossío-Zazueta A, Manjares-Cuenca J, Lozano-Morales M, Loya-Silva J. Correlación de las alteraciones de los vasos arteriales tibiales, con los años de evolución de la diabetes mellitus. Rev Mex Angiol 2002; 30: 120-4.

27. Sierra Juárez MA, Serrano Lozano J, Sánchez Nicolat N, Cossío Zazueta A, Hernández G, Serrano E, Muñoa A, Cal y Mayor I, Nuricumbo A, Huerta H, Rodríguez A, García J. Relación de lesiones arteriográficas en vasos tibiales en el salvamento de extremidades de pacientes diabéticos. Rev Mex Angiol 2004; 32: 71-6.

28. Lavery LA, Armstrong DG, Wunderlich RP, Tredwell J, Boulton AJM. Diabetic foot syndrome: Evaluating the prevalence and incidence of foot pathology in Mexican Americans and non-Hispanic whites from a diabetes dis-ease management cohort. Diabetes Care 2003; 26(5): 1435-8.

29. Nehler MR, Hiatt WR, Taylor LM, Jr. Is revascularization and limb salvage always the best treatment for critical limb ischemia? J Vasc Surg 2003; 37: 704-8.