Surmann Johanna, Meyer Philipp, Epple Jasmin, Schmitz-Rixen Thomas, Böckler Dittmar, Grundmann Reinhart T
Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany.
Department of Vascular and Endovascular Surgery, University Hospital Frankfurt am Main, 60596 Frankfurt am Main, Germany.
Biomedicines. 2023 Dec 22;12(1):38. doi: 10.3390/biomedicines12010038.
To present the short- and long-term outcomes of lower extremity bypass (LEB) surgery in patients with critical limb-threatening ischaemia (CLTI), comparing diabetic (DM) and non-diabetic (non-DM) patients.
Retrospective analysis of anonymised data from a nationwide health insurance company (AOK). Data from 22,633 patients (DM: = 7266; non-DM: = 15,367; men: = 14,523; women: = 8110; mean patient age: 72.5 years), who underwent LEB from 2010 to 2015, were analysed. The cut-off date for follow-up was December 31, 2018 (mean follow-up period: 55 months).
Perioperative mortality was 10.0% for DM and 8.2% for non-DM ( < 0.001). Patients with crural/pedal bypasses ( = 8558) had a significantly higher perioperative mortality (10.3%) than those with above-the-knee ( = 7246; 5.8%; < 0.001) and below-the-knee bypasses ( = 6829; 8.9%; = 0.003). The 9-year survival rates in DM patients were significantly worse, at 21.5%, compared to non-DM, at 31.1% ( < 0.001). This applied to both PAD stage III (DM: 34.4%; non-DM: 45.7%; < 0.001) and PAD stage IV (DM: 18.5%; non-DM: 25.0%; < 0.001). Patients with crural/pedal bypasses had a significantly inferior survival rate (25.5%) compared to those with below-the-knee (27.7%; < 0.001) and above-the-knee bypasses (31.7%; < 0.001).
Perioperative and long-term outcomes regarding survival and major amputation rate for CLTI patients undergoing LEB are consistently worse for DM patients compared to non-DM patients.
呈现下肢旁路移植术（LEB）治疗严重肢体缺血（CLTI）患者的短期和长期结果，比较糖尿病（DM）患者和非糖尿病（非DM）患者。
对一家全国性健康保险公司（AOK）的匿名数据进行回顾性分析。分析了2010年至2015年期间接受LEB手术的22633例患者的数据（DM患者：7266例；非DM患者：15367例；男性：14523例；女性：8110例；患者平均年龄：72.5岁）。随访截止日期为2018年12月31日（平均随访期：55个月）。
DM患者围手术期死亡率为10.0%，非DM患者为8.2%（P<0.001）。行小腿/足部旁路移植术的患者（8558例）围手术期死亡率（10.3%）显著高于膝上旁路移植术患者（7246例；5.8%；P<0.001）和膝下旁路移植术患者（6829例；8.9%；P=0.003）。DM患者的9年生存率显著低于非DM患者，分别为21.5%和31.1%（P<0.001）。这在下肢动脉硬化闭塞症（PAD）III期（DM患者：34.4%；非DM患者：45.7%；P<0.001）和PAD IV期（DM患者：18.5%；非DM患者：25.0%；P<0.001）均如此。与膝下旁路移植术患者（27.7%；P<0.001）和膝上旁路移植术患者（31.7%；P<0.001）相比，行小腿/足部旁路移植术的患者生存率显著更低（25.5%）。
与非DM患者相比，接受LEB手术的CLTI患者在围手术期及生存和大截肢率方面的长期结果，DM患者始终更差。
