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Influence of diabetes on revascularisation procedures of the aorta and lower limb arteries: early results.

OBJECT
to evaluate the influence of diabetes mellitus on the therapeutic indications and the one-month results in patients with occlusive disease of the aorta and/or lower limbs arteries.


MATERIAL
a retrospective study of fully computerised data of 1003 patients (753 men, 250 women) admitted consecutively to our vascular surgery unit over a 5-year period (1992-1996). Of the total, 169 were diabetics (group I) and 834 were non-diabetics (group II). Sixty-two per cent of patients in group I vs. 40% in group II presented with critical ischaemia or trophic changes (p<0.001).


RESULTS
15.4% of patients in group I vs. 4.1% in group II had primary amputation because of irreversible ischaemia or because arterial reconstruction was impossible. Of those who underwent revascularisation, 80% were infrainguinal in group I vs. 50% in group II. Forty-five per cent of patients in group I and 37% in group II had a percutaneous transluminal angioplasty (PTA) and approximately 3% in both groups had a combination of the two techniques. At one month, patients alive without major amputation numbered 64.4% in group I vs. 93.6% in group II, patients alive with major amputation numbered 26.6% in group I vs. 5.5% in group II, and mortality rates were 8.9% in group I vs. 0.8% in group II (P<0.001).


CONCLUSIONS
the 5-times higher amputation and 10-times higher mortality rates for diabetics compared to non-diabetics call for better collaborative management of diabetics between general practitioners, vascular surgeons, diabetologists and cardiologists. PTA with a 90% initial success rate is indicated for short lesions even in the presence of limited gangrene.