Diabetes and the outcome of infrainguinal bypass for critical limb ischaemia

Aim: To examine the influence of diabetes mellitus (DM) on the outcome of infrainguinal bypass operations performed for critical foot ischaemia in Chinese patients. Methods: A prospective audit of 265 consecutive infrainguinal bypass operations. Results: Diabetic patients suffered more frequently from ischaemic heart disease (48%vs 25%, P= 0.001) and tissue loss (90%vs 79%, P = 0.01) at presentation. Cigarette smoking was more prevalent in the non‐diabetic (NDM) group (72%vs 51%, P = 0.001). Arterial segments distal to the common femoral artery were more often used as inflow to bypass graft in DM patients (36%vs 22%, P = 0.02). Operative mortality (seven DM vs one NDM, P = 0.19). Early graft failure (7% in DM group vs 10% in NDM group, P = 0.24), wound infection rate (24% in DM group vs 17% in NDM group, P = 0.21), early limb loss (9% in DM group vs 6% in NDM group, P = 0.66) were comparable. However, hospital mortality was higher in DM patients (8%vs 1%, P = 0.04). DM patients more frequently required further surgical debridement postoperatively (20%vs 9%, P = 0.04). Long‐term, patient survival was inferior in the DM group (43% NDM vs 33% DM at 5 years, P = 0.03). Primary graft patency (46% DM vs 34% NDM at 4 years P = 0.19), secondary graft patency (57% DM vs 47% NDM at 4 years P = 0.14) and limb salvage rate (78%vs 81% at 5 years, P = 0.79) were comparable. Conclusion: Diabetes mellitus adversely affects hospital mortality and long‐term survival. Graft patency and limb salvage are not compromised by the presence of DM.