Efficacy of the dorsal pedal bypass for limb salvage in diabetic patients: short-term observations

Diabetic patients with ischemic disease of the lower leg (decreased blood supply to the leg, often characterized by pain) are not often considered to be candidates for vascular reconstruction surgery. Digital subtraction angiography (DSA) is a vascular imaging technique that has been used by the authors to improve visualization of the distal arteries of the feet and legs of such patients. As a result of this testing, a group of patients likely to benefit from vascular surgery can be identified. The results of a review of the medical records of 96 patients are presented. These patients had extensive disease of the tibial arteries of the lower leg, but the dorsal pedal artery (in the foot) was found to be open. Of this group, 94 percent had diabetes and underwent 97 bypass grafts, which were placed to the dorsal pedal artery. (In a bypass graft, a vein or prosthetic vascular material is grafted to an artery, so that blood flow bypasses a segment of a diseased artery.) All procedures were performed in order to save the limb from amputation. The most common indications for surgery were ischemic ulcer of the foot, secondary infection, pain at rest, and gangrene (death of tissue, usually due to ischemia, followed by bacterial invasion and subsequent decay). The patients (44) with secondary infection were treated with antibiotics prior to surgery. In 92 cases (88.5 percent of total cases) the dorsal pedal artery was visualized with DSA; 91 bypasses were performed. Of 12 cases in which the dorsal pedal artery could not be seen on DSA, but blood flow was audible on continuous wave Doppler (ultrasound) examination, bypass was successful in six cases. Two patients died within 30 days of surgery. However, at the time of hospital discharge, the feet of 89 patients were considered to have been saved. Eighteen months later, actuarial studies revealed graft patency (remaining open) to be 81.8 percent, limb salvage 86.9 percent, and patient survival 80 percent. To avoid overlooking the potential option of vascular reconstruction, especially for diabetic patients, it is recommended that an attempt always be made to visualize the blood vessels of the foot by means of angiography. (Consumer Summary produced by Reliance Medical Information, Inc.)