Femoral Grafts in Diabetics:  Resulting Conservative Amputations

The diabetic patient, particularly if his primary disease has been poorly regulated, comes to face many problems. One of the more serious of these concerns the circulation to the lower extremity, which all too frequently deteriorates to such an extent that a major amputation becomes necessary. The pathologic changes in the artery wall of diabetics and nondiabetics are similar—but the former group is prone to develop occlusions in the arteries below the knee level. This is shown by the common occurrence of gangrene in the diabetic with a good popliteal pulse (40% of all diabetics seen). Obviously, if a combination of femoral occlusion and poor tibial arteries exists, serious trouble results—a fact which accounts for the high incidence of ischemic rest pain and gangrene in the patients who require femoral artery grafts. In addition, the diabetic has more generalized arteriosclerotic changes in the femoral and popliteal arteries, is less able