tailieunhanh - Diabetes in Old Age - part 4

tĩnh mạch có thể được sử dụng nhưng điều này cho biết thêm đến các khía cạnh kỹ thuật và thời gian hoạt động. Nếu chiều dài ngắn của tĩnh mạch có thể được tìm thấy, động mạch thuộc về nhượng chân để vượt qua chân có thể được gần như là thành công như động mạch đùi | THE DIABETIC FOOT 81 vein can be used but this adds to the technical aspects and duration of the operation. If a short length of vein can be found popliteal artery to foot bypass may be almost as successiul as femoral artery to distal bypass Pomposelli et al 1991 . Similarly the patient must have suitable anatomy with adequate inflow and a patent foot vessel to graft on to. If the nature and extent of infection and necrosis is such that it encroaches upon the potential graft site then again the likelihood is that the graft will fail. This once again highlights the need for control of infection. Any centre which wishes to perform reconstructive surgery and particularly distal surgery needs to operate a graft surveillance program in order to assess the clinical progress of patients and to audit results. In the follow-up period the other vascular trees coronaries carotids and the other limb may need attention to reduce the coexisting morbidity and mortality and to improve patient outcome. The nature of diabetes as a systemic disorder usually implies that in those patients requiring reconstructive surgery there are other associated complications. This is particularly true of the elderly patient with diabetes. Intensive care time is often longer in diabetic patients and the perioperative management of diabetes control cardiac and renal impairment and radiological investigation require a team approach to the management of surgery in such patients Hirsch and White 1988 . Proximal Arterial Reconstruction These operations are divided into inflow procedures usually aorto-iliac surgery where synthetic graft materials are usually used and where because of high flow rates the graft patency is excellent. For aorto-bifemoral grafts the 5-year patency rate is commonly over 85 . The patency of aorto-bifemoral grafts is the same in the diabetic and non-diabetic patient but because of associated cardiovascular disease overall patient survival rates are lower in diabetic patients but