Long-Term Outcome of Lower Extremity Bypass Surgery in Diabetic and Non-Diabetic Patients with Critical Limb-Threatening Ischaemia in Germany
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Patients
2.3. Statistics
3. Results
3.1. Patients
3.2. Perioperative Outcome
3.3. Long-Term Survival in PAD Stages III and IV
3.4. Long-Term Survival Depending on Bypass Level
3.5. Major Amputation Rates during Follow-Up in PAD Stages III and IV
3.6. Major Amputation Rates during Follow-Up Depending on Bypass Level
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Non-DM n = 15,367 | DM n = 7266 | p Value | |
---|---|---|---|
Male sex, n (%) | 9930 (64.6) | 4593 (63.2) | 0.040 |
Female sex, n (%) | 5437 (35.4) | 2673 (36.8) | 0.040 |
PAD Fontaine stage III, n (%) | 4641 (30.2) | 1419 (19.5) | <0.001 |
PAD Fontaine stage IV, n (%) | 10,726 (69.8) | 5847 (80.5) | <0.001 |
Bypass above-the-knee PAD III, n (%) | 1735 (37.4) | 564 (39.7) | 0.109 |
Bypass below-the-knee PAD III, n (%) | 1525 (32.9) | 438 (30.9) | 0.160 |
Bypass crural/pedal PAD III, n (%) | 1381 (29.8) | 417 (29.4) | 0.790 |
Bypass above-the-knee PAD IV, n (%) | 3292 (30.7) | 1655 (28.3) | 0.001 |
Bypass below-the-knee PAD IV, n (%) | 3232 (30.1) | 1634 (27.9) | 0.003 |
Bypass crural/pedal PAD IV, n (%) | 4202 (39.2) | 2558 (43.7) | <0.001 |
Age, mean ± SD in years; median (min-max) | 72.2 ± 10.8; 73 (19–101) | 73.2 ± 9.7; 74 (28–100) | <0.001 |
Age men, mean ± SD in years; median (min-max) | 69.6 ± 10.3; 71 (19–99) | 71.3 ± 9.4; 73 (28–95) | <0.001 |
Age women, mean ± SD in years; median (min-max) | 76.8 ± 10.3; 78 (27–101) | 76.5 ± 9.4; 78 (41–100) | 0.015 |
Arterial hypertension, n (%) | 6154 (40.0) | 6017 (82.8) | <0.001 |
Left heart failure (NYHA 2-4 and unspecified), n (%) | 1675 (10.9) | 2394 (32.9) | <0.001 |
History of myocardial infarction, n (%) | 1058 (6.9) | 1487 (20.5) | <0.001 |
History of stroke, n (%) | 450 (2.9) | 490 (6.7) | <0.001 |
History of TIA, n (%) | 217 (1.4) | 192 (2.6) | <0.001 |
COPD, n (%) | 1542 (10.0) | 1250 (17.2) | <0.001 |
Renal insufficiency (stages 3–5), n (%) | 1707 (11.1) | 2655 (36.5) | <0.001 |
Non-DM n = 15,367 | DM n = 7266 | p Value | |
---|---|---|---|
Perioperative mortality all patients, n (%) | 1259 (8.2) | 729 (10.0) | <0.001 |
Perioperative mortality men, n (%) | 729/9930 (7.3) | 418/4593 (9.1) | <0.001 |
Perioperative mortality women, n (%) | 530/5437 (9.7) | 311/2673 (11.6) | 0.009 |
Perioperative mortality PAD III, n (%) | 199/4641 (4.3) | 76/1419 (5.4) | 0.091 |
Perioperative mortality PAD IV, n (%) | 1060/10,726 (9.9) | 653/5847 (11.2) | 0.009 |
Perioperative mortality above-the-knee bypass, n (%) | 317/5027 (6.3) | 178/2219 (8.0) | 0.008 |
Perioperative mortality below-the-knee bypass, n (%) | 384/4757 (8.1) | 225/2072 (10.9) | <0.001 |
Perioperative mortality crural/pedal bypass, n (%) | 558/5583 (10.0) | 326/2975 (11.0) | 0.163 |
LOS, mean ± SD in days; median (min-max) | 25.6 ± 19.7; 20 (0–298) | 28.9 ± 22.2; 22 (1–232) | <0.001 |
Major amputation, n (%) | 892 (5.8) | 539 (7.4) | <0.001 |
Minor amputation, n (%) | 2676 (17.4) | 2103 (28.9) | <0.001 |
Dialysis, n (%) | 478 (3.1) | 536 (7.4) | <0.001 |
Blood transfusions, n (%) | 6027 (39.2) | 3613 (49.7) | <0.001 |
Intensive care treatment, n (%) | 2607 (17.0) | 1587 (21.8) | <0.001 |
Wound infections, n (%) | 1639 (10.7) | 868 (11.9) | 0.004 |
Myocardial infarction, n (%) | 344 (2.2) | 223 (3.1) | <0.001 |
Complication-free, n (%) | 10,636 (69.2) | 4100 (56.4) | <0.001 |
Non-DM n = 15,367 | DM n = 7266 | p Value | |
---|---|---|---|
Survival all patients, n (%) | 6354 (31.1) | 2373 (21.5) | <0.001 |
Survival PAD III, n (%) | 2652 (45.7) | 692 (34.3) | <0.001 |
Survival PAD IV, n (%) | 3702 (25.0) | 1681 (18.5) | <0.001 |
Survival above-the-knee bypass PAD III, n (%) | 1068 (49.4) | 290 (37.9) | <0.001 |
Survival below-the-knee bypass PAD III, n (%) | 858 (45.5) | 211 (33.1) | <0.001 |
Survival crural/pedal bypass PAD III, n (%) | 726 (41.3) | 191 (32.3) | 0.001 |
Survival above-the-knee bypass PAD IV, n (%) | 1227 (27.0) | 518 (21.5) | <0.001 |
Survival below-the-knee bypass PAD IV, n (%) | 1109 (23.4) | 474 (17.3) | <0.001 |
Survival crural/pedal bypass PAD IV, n (%) | 1366 (24.3) | 689 (17.2) | <0.001 |
HR | 95% CI | p Value | |
---|---|---|---|
Male gender (vs. female gender) | 1.16 | 1.12–1.21 | <0.001 |
Age (increased by 1 year) | 1.04 | 1.04–1.05 | <0.001 |
Bypass crural/pedal and below-the-knee (vs. above-the-knee) | 1.02 | 0.98–1.06 | 0.323 |
PAD Fontaine stage IV (vs. III) | 1.62 | 1.55–1.69 | <0.001 |
Diabetes mellitus type 2 | 1.10 | 1.05–1.14 | <0.001 |
Left heart failure (NYHA 2-4 and unspecified) | 1.28 | 1.22–1.35 | <0.001 |
COPD | 1.35 | 1.29–1.42 | <0.001 |
Renal insufficiency (stages 3–5) | 1.44 | 1.38–1.51 | <0.001 |
Arterial hypertension | 0.90 | 0.87–0.94 | <0.001 |
History of myocardial infarction | 1.05 | 0.99–1.11 | 0.102 |
History of stroke | 1.18 | 1.09–1.28 | <0.001 |
Non-DM n = 15,367 | DM n = 7266 | p Value | |
---|---|---|---|
Major amputation rates all patients, n (%) | 4114 (39.0) | 2197 (45.3) | <0.001 |
Major amputation rates PAD III, n (%) | 976 (29.9) | 319 (31.5) | 0.005 |
Major amputation rates PAD IV, n (%) | 3138 (43.7) | 1878 (49.3) | <0.001 |
Major amputation rates above-the-knee bypass PAD III, n (%) | 257 (22.4) | 83 (23.5) | 0.283 |
Major amputation rates below-the-knee bypass PAD III, n (%) | 297 (29.9) | 90 (32.7) | 0.117 |
Major amputation rates crural/pedal bypass PAD III, n (%) | 422 (39.8) | 146 (40.7) | 0.018 |
Major amputation rates above-the-knee bypass PAD IV, n (%) | 715 (35.2) | 432 (40.7) | <0.001 |
Major amputation rates below-the-knee bypass PAD IV, n (%) | 856 (41.1) | 463 (49.6) | 0.002 |
Major amputation rates crural/pedal bypass PAD IV, n (%) | 1567 (52.4) | 983 (55.5) | 0.007 |
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Surmann, J.; Meyer, P.; Epple, J.; Schmitz-Rixen, T.; Böckler, D.; Grundmann, R.T., on behalf of the DIGG. Long-Term Outcome of Lower Extremity Bypass Surgery in Diabetic and Non-Diabetic Patients with Critical Limb-Threatening Ischaemia in Germany. Biomedicines 2024, 12, 38. https://doi.org/10.3390/biomedicines12010038
Surmann J, Meyer P, Epple J, Schmitz-Rixen T, Böckler D, Grundmann RT on behalf of the DIGG. Long-Term Outcome of Lower Extremity Bypass Surgery in Diabetic and Non-Diabetic Patients with Critical Limb-Threatening Ischaemia in Germany. Biomedicines. 2024; 12(1):38. https://doi.org/10.3390/biomedicines12010038
Chicago/Turabian StyleSurmann, Johanna, Philipp Meyer, Jasmin Epple, Thomas Schmitz-Rixen, Dittmar Böckler, and Reinhart T. Grundmann on behalf of the DIGG. 2024. "Long-Term Outcome of Lower Extremity Bypass Surgery in Diabetic and Non-Diabetic Patients with Critical Limb-Threatening Ischaemia in Germany" Biomedicines 12, no. 1: 38. https://doi.org/10.3390/biomedicines12010038