Diabetics Give Limb Ischemia Surgery Mixed Reviews

By Mark S. Lesney  

Diabetic patients report significantly less sense of improvement in health-related quality of life at 6 months after infrageniculate bypass surgery than do their nondiabetic counterparts, according to Dr. Michael Engelhardt and his colleagues in Germany.

In a prospective study, a health-related quality of life (HRQOL) questionnaire was used to compare results between baseline (before surgery) and 6 months after surgery in 86 consecutive patients undergoing infrageniculate bypass grafting for critical limb ischemia, the researchers reported in the European Journal of Vascular and Endovascular Surgery (2006;32:182-98).

Men made up 72% of the total population, and the median age was 71 years. Patient survival, limb salvage, and amputation-free survival rates were 87.6%, 83.1%, and 77.9%, respectively. Primary patency, assisted primary patency, and secondary patency rates were 79.1%, 88.6%, and 93.7%, respectively. There were 53 patients with diabetes mellitus.

A subgroup analysis comparing these patients with the 33 nondiabetic individuals showed no significant difference in any of these outcome measures, according to Dr. Engelhardt of the division of vascular surgery at the Military Hospital Ulm, Ulm/Donau, Germany, and his colleagues.

The eight HRQOL parameters measured were physical functioning index, role physical index, pain, social functioning index, mental health index, role emotional index, vitality, and general health perception index.

Baseline HRQOL values revealed no significant difference between the two subgroups except for role emotional index (role limitations due to emotional problems), which was lower in patients with diabetes. At 6 months after bypass surgery, however, all quality of life scores were significantly better in the nondiabetic group, despite improvement for both groups in all qualities measured over baseline.

The authors suggested that a 6-month follow-up might be too short for complete surgical recovery in diabetic patients, especially since ischemic wounds were the indication for surgery more often in diabetic (88.7%) than nondiabetic patients (69.7%).

Despite the discrepancy seen at 6 months, however, "an aggressive approach toward infrageniculate bypass surgery seems to be justified in diabetic and nondiabetic patients with critical limb ischemia since both groups do benefit from surgery with regard to their quality of life, albeit to a different extent," concluded the researchers.

When asked to comment on this article, Dr. John Hallett, clinical professor of surgery, Medical University of South Carolina, stated: "Diabetes has both a physiologic and emotional impact on the patient and everyone around them. This article reveals that diabetics may need additional psychologic support from medication or a therapist who can help the patient and family following the revascularization."