Perioperative Blood Glucose Levels Influence Outcome After Infrainguinal Bypass and Endovascular Therapy

Poor perioperative blood glucose management is associated with increased morbidity and mortality after infrainguinal and coronary artery bypass surgery. The influence of perioperative hyperglycaemia on restenosis and patency following infrainguinal revascularisation among diabetic patients is largely unknown. Consecutive diabetic patients undergoing primary infrainguinal bypass surgery (BS) or endovascular therapy (EV) for critical limb ischaemia were identified. Daily capillary blood glucose (CBG) data was collected retrospectively up to 7 days post operatively along with pre and 3 month post procedural haemoglobin A1C levels and analysed against the study endpoints (primary, assisted primary and secondary patency and binary restenosis). In patients undergoing infra-inguinal bypass (N = 42) a mean peri-operative CBG level greater than 7 mmol/L was associated with reduced primary patency (P = 0.01) and a higher level of binary restenosis (P = 0.042), with no significant difference in assisted primary patency (P =.36) and secondary patency (P = .46). A lower primary patency was also found in patients with a HbA1C level of greater than 48 mmol/mol both pre (P = 0.027) and 3 months post operatively (P = 0.047). The EV group consisted of 76 patients with 160 vessels treated. A high perioperative CBG level (>7) and HbA1C level (>48) was associated with lower primary patency (P = .011 and P.004), assisted primary patency (P = .019 and P = .004), secondary patency (P =.047 and P =.018) and a higher binary restenosis rate (P = 0.042 and P = .032). Cox regression analysis showed high pre-procedural HBA1C levels (P = 0.001) and CBG level (P = 0.02) to be an independent predictor of patency. Poor perioperative glycaemic control is associated with lower patency and higher incidence of restenosis after infrainguinal revascularisation in diabetic patients.