Journal
DIABETES-METABOLISM RESEARCH AND REVIEWS
Volume 32, Issue -, Pages 239-245Publisher
WILEY
DOI: 10.1002/dmrr.2753
Keywords
limb-threatening ischaemia; critical limb ischaemia; PAD in diabetes; diabetic foot ulcer; revascularization; angioplasty; lower extremity bypass
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The confluence of several chronic conditions - in particular ageing, peripheral artery disease, diabetes, and chronic kidney disease - has created a global wave of lower limbs at risk for major amputation. While frequently asymptomatic or not lifestyle limiting, at least 1% of the population has peripheral artery disease of sufficient severity to be limb threatening. To avoid the critical error of failing to diagnose ischaemia, all patients with diabetic foot ulcers and gangrene should routinely undergo physiologic evaluation of foot perfusion. Ankle brachial index is useful when measurable, but may be falsely elevated or not obtainable in as many as 30% of patients with diabetic foot ulcers primarily because of medial calcinosis. Toe pressures and skin perfusion pressures are applicable to such patients. Copyright (c) 2016 John Wiley & Sons, Ltd.
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