Objectively controlled vascular surgery in diabetics with chronic ischemic ulceration of the feet and rest pain
Elbirk, A.; Tønnesen, K.H.; Kristensen, P.; Sager, P.
Ugeskrift for Laeger 143(49): 3283-3287
1981
ISSN/ISBN: 0041-5782 PMID: 7331039 Document Number: 174018
Reconstructions (43) of leg arteries were carried out in 35 diabetics from 1975-1980. All suffered from rest pain and chronic ulcers, 2/3 had neuropathy. The average age was 63 yr (range 44-87). Preoperative toe blood pressure measured with straingauge technique averaged 11% of arm systolic pressure. Combined intraarterial and noninvasive segmental pressures were recorded in 29 extremities, where the angiogram gave suspicion of 2 or 3 level disease. This technique predicted the result of 1 level reconstuction in multilevel disease and thus to minimize the procedures. Analysis of segmental pressures in 7 cases of re-occlusion within 2 mo. revealed pressure gradients at the calf arteries > 30% and a femoral-to-ankle pressure gradient > 40% of arm systolic pressure. Postoperative measurements indicated that 3 femoro-popliteal anastomoses should have been revised. Quantitative limits for runoff are given, which improve future results. By preoperative pressure recording 4 primary failures were avoided. Of the patients 59% still had their limb at an average time of 20 mo., and 43% had patent arteries according to the pressure readings at an average time of 2 yr.