title: Peripheral arterial disease and bypass surgery in the diabetic lower limb.
abstract: PAD is very common in people with diabetes and is one of the strongest predictors of developing nonhealing foot ulcers and suffering amputation. There is strong evidence to show that early detection of PAD and revascularization will reduce amputations. Despite this, many patients have no vascular assessment even when they present with a foot ulcer or before amputation. Even when identified, patients are referred late, which worsens their outcome. Currently there is no evidence to support surgical revascularization over endovascular treatments, but in reality the techniques are complementary and the choice of revascularization procedure should be determined by an experienced multidisciplinary vascular team. Surgical revascularization can achieve good results but careful patient selection, operative planning, and the use of autologous vein are necessary. What is clearly apparent is that at present not enough patients are being offered revascularization to prevent amputation.
authors.affiliation: Department of Vascular Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD, UK.
authors.forename: Mostafa A
authors.initials: MA
authors.lastname: Albayati
authors.forename: Clifford P
authors.initials: CP
authors.lastname: Shearman
mesh_terms: D000671:Amputation, Surgical / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000601:surgery; D017719:Diabetic Foot / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000601:surgery; D007866:Leg / Q000098:blood supply* / Q000601:surgery*; D023821:Limb Salvage / Q000379:methods*; D058729:Peripheral Arterial Disease / Q000601:surgery*; D012720:Severity of Illness Index; D014654:Vascular Patency
keywords: Diabetes; Lower limb amputation; Peripheral arterial disease; Surgical revascularization