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Outcome after leg bypass surgery for critical limb ischemia is poor in patients with diabetes: a population-based cohort study

Jonas Malmstedt, MD^*, Karin Leander, PhD, Eric Wahlberg, MD, Prof^*, Lars Karlström, D, PhD, Lars Alfredsson, Prof. and Jesper Swedenborg, MD, Prof^*

^*Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden

Jonas.Malmstedt{at}Karolinska.se

ABSTRACT

Objective: Our aim was to assess the risk of major amputation or death after leg bypass surgery for critical limb ischemia in patients with diabetes compared to patients without diabetes.

Research Design And Methods: We did a population-based cohort study by linking nationwide databases in Sweden. We identified 1840 patients in the Swedish Vascular Registry who had their first leg bypass procedure for critical lower limb ischemia from January 1, 2001 to December 31, 2003, 742 with, and 1098 without diabetes. Our primary endpoint was a composite of first major amputation of the limb on which bypass was done, or death. Individuals were followed up until December 31, 2005 through the National Hospital Patient Registry and the Cause-of-death Registry.

Results: Incidence of ipsilateral amputation or death was higher in patients with diabetes than in patients without (30.2 vs. 22.0 events per 100 person-years; crude hazard ratio [HR] 1.32; 95% CI 1.17-1.50). Similarly, individuals with diabetes had shorter amputation-free survival than individuals without (2.3 years; 1.9-2.8 vs. 3.4 years; 3.1-3.7).

Adjustment for demographic characteristics, comorbidities and risk factors for amputation or death did not substantially affect the risk (HR 1.46; 1.26-1.69). The effect was more pronounced in male (HR 1.75; 1.47-2.08) than in female patients (1.35; 1.11-1.64) after adjustment for age.

Conclusions: Diabetes is associated with lower amputation-free survival after leg bypass for critical limb ischemia. Patients with diabetes and limb ischemia need intensified treatment of diabetes-related risk factors to improve outcome.

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