The influence of diabetes on short-term outcome following a prosthetic above-the-knee femoro-popliteal bypass

OBJECTIVES: To assess the influence of diabetes mellitus on early morbidity and mortality following a femoro-popliteal bypass. METHODS: Clinical data on patients subjected to a prosthetic above-the-knee femoro-popliteal bypass for atherothrombotic disease over a four-year period in the Durban Metropolitan Vascular Service were culled from a prospectively maintained computerised database. The patients were divided into two groups, diabetic and non-diabetic. RESULTS: Two hundred and seventeen patient records were analysed; 102 (47%) patients were diabetic and 115 (53%) non-diabetic. The mean age in the two groups was almost similar. Differences noted between the two groups were that there was a higher prevalence of males and cigarette smokers in the non-diabetic group and hypertension among the diabetics. The prevalence of ischaemic heart disease in the two groups was not statistically significant. The majority of patients in both groups presented with critical limb ischaemia. Overall, 208 (96%) of the patients had their procedures performed using loco regional anaesthesia. The incidence of superficial wound infection between the two groups was not statistically significant. Deep infection, which necessitated removal of the graft, and cardiovascular complications were significantly higher in the diabetics. Four patients (3.9%) in the diabetic group and only one (0.9%) in the non-diabetic group died. CONCLUSION: Diabetes mellitus significantly increases the incidence of graft sepsis and cardiovascular morbidity in patients undergoing above-the-knee femoro-popliteal bypass.