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Challenges of distal bypass surgery in patients with diabetes: Patient selection, techniques, and outcomes  Michael S. Conte, MD  Journal of Vascular.

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Presentation on theme: "Challenges of distal bypass surgery in patients with diabetes: Patient selection, techniques, and outcomes  Michael S. Conte, MD  Journal of Vascular."— Presentation transcript:

1 Challenges of distal bypass surgery in patients with diabetes: Patient selection, techniques, and outcomes  Michael S. Conte, MD  Journal of Vascular Surgery  Volume 52, Issue 3, Pages 96S-103S (September 2010) DOI: /j.jvs Copyright © 2010 Society for Vascular Surgery and the American Podiatric Medical Association Terms and Conditions

2 Fig 1 The PIII Risk Score was developed to predict amputation-free survival (AFS) following lower extremity bypass for CLI, using preoperative variables. Risk calculator shown on left panel, with bar graph showing stratified outcomes from the PREVENT III clinical trial. Right panel shows results of a validation study in the multicenter Vascular Study Group of Northern New England (VSGNNE) cohort of 1166 patients who underwent vein bypass for CLI (from9,10). Journal of Vascular Surgery  , 96S-103SDOI: ( /j.jvs ) Copyright © 2010 Society for Vascular Surgery and the American Podiatric Medical Association Terms and Conditions

3 Fig 2 Vein quality is the dominant factor in determining long term outcome of LEB for CLI. Data from post-hoc analyses of the PREVENT III multicenter cohort. A, Influence of vein diameter on graft patency. B, Relationship of vein type (Composite, spliced vein segments; LSV, lesser saphenous vein; SSGSV, single segment great saphenous vein) to patency. C, Performance of “optimal vein conduits” (SSGSV ≥ 3.5mm) in the PREVENT III trial; note that distal anastomotic site has minimal influence on the patency of these grafts. (A, B, from19; C, unpublished data from PREVENT III clinical trial). Journal of Vascular Surgery  , 96S-103SDOI: ( /j.jvs ) Copyright © 2010 Society for Vascular Surgery and the American Podiatric Medical Association Terms and Conditions

4 Fig 3 Distal origin vein grafts (DOGs; inflow from superficial femoral or popliteal arteries) are particularly useful and effective in diabetic patients. A, Secondary patency and B, Limb salvage rates for DOGs in a series of 190 diabetic and 90 non-diabetic subjects (P < .04; from33). Journal of Vascular Surgery  , 96S-103SDOI: ( /j.jvs ) Copyright © 2010 Society for Vascular Surgery and the American Podiatric Medical Association Terms and Conditions

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