Leg bypass surgery outcome poor in diabetics
NEW YORK (Reuters Health) - Patients with diabetes fare worse than their non-diabetic counterparts after leg bypass surgery to restore restricted blood flow to the legs due to hardening of the leg arteries, Swedish researchers report.
They found that survival free of amputation after leg bypass surgery for severely reduced blood flow to the legs (i.e., critical limb ischemia) is lower in diabetics than non-diabetics, and death associated with this procedure is also higher among diabetics.
Dr. Jonas Malmstedt of Karolinska University Hospital, Stockholm and colleagues note that patients with critical limb ischemia usually require leg bypass surgery to prevent amputation. They also point out that there is a lack of population-based studies involving diabetics.
To assess what extra risks patients with diabetes might be subject to following the procedure, the researchers studied national data on 742 patients with diabetes and 1098 patients without diabetes, who all underwent leg bypass surgery.
They report in the journal Diabetes Care that diabetics had a 55 percent increased risk of major amputation or death and, on average, survived for less than 1 year without amputation. Adjustment for a variety of factors, including the degree of limb ischemia had no substantial influence on the results.
After adjustment for age, the researchers found that the effect of diabetes was more pronounced in men than it was in women.
Patients with severe limb ischemia and diabetes, Malmstedt concluded, bear a "heavy burden of disease" from multiple manifestations of both hardening of the arteries and diabetes complications. "Treating this group of patients is a challenge and requires collaboration of a broad range of specialties to be successful."
SOURCE: Diabetes Care, May 2008.
