Patency of Reverse Saphenous Vein Graft for Revascularization of Lower Limbs in Diabetic Patients
Journal Title: International Journal of Vascular Surgery and Medicine - Year 2016, Vol 2, Issue 1
Abstract
Objectives: Diabetic patients are prone to early development of vasculopathy, resulting in lower limb ischemia, which can lead to non-healing ulcers, foot infection, loss of limb, and even death. These patients need revascularization of their limb either using endovascular or open surgical techniques. Not all patients are suitable for endovascular treatment warranting the open surgical revascularization techniques. The objective of this study was to evaluate the patency of arterial bypass grafting using reverse saphenous vein graft in the treatment of peripheral vascular disease of the lower limbs in diabetic patients. Patients and Methods: Between January 2004 and December 2014, 218 diabetic patients with lower limb ischemia of Fontaine class III and IV underwent distal arterial bypass grafting with autologous reverse saphenous vein graft. Another group of 103 patients where the saphenous vein was ether previously used or not suitable as conduit underwent revascularization using synthetic ePTFE graft. Patency of the grafts, overall effectiveness of revascularization, improvement in symptoms, and healing of ulcers were assessed at short-term (three months) and long-term (mean 20.6 ±6.6 months) follow-up. Results: At short-term follow-up, 88% of grafts were patent. Fifty-two percent of ischemic ulcers had healed, and severe ischemic symptoms (rest pain, claudication, ischemic ulcers, limitation of physical activities, and worsening of glycemic control) had improved or were resolved in 87% of patients. Compared to the synthetic graft group, 71% graft were patent on short term follow up. Amputation of a limb was required in 11% of patients even after revascularization. Renal impairment worsened, requiring renal transplantation, in 8% of patients who had undergone revascularization. Eight (4%) patients died in long-term follow-up but none from complications of the revascularization. Conclusions: A high percentage of autologous reverse saphenous vein grafts placed in diabetic patients with peripheral vascular disease are patent at long-term follow-up. The revascularization reduces the rates of amputation, helps in ulcer healing, and relieves ischemic symptoms. Comparing with the group of patients, where revascularization was achieved using synthetic grafts, a higher percentage patent grafts were found in autologous reverse saphenous vein grafts group.
Authors and Affiliations
Khan Mohammad Iqbal, Rahman Habib ur, Mufti Naveed
Keywords
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- EP ID EP347067
- DOI 10.17352/2455-5452.000015
- Views 91
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