title: Lower limb ischaemia in patients with diabetic foot ulcers and gangrene: recognition, anatomic patterns and revascularization strategies.
abstract: 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.
authors.affiliation: Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Mills
mesh_terms: D001162:Arteriosclerosis Obliterans / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation / Q000628:therapy; D003131:Combined Modality Therapy / Q000009:adverse effects; D003226:Congresses as Topic; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000503:physiopathology / Q000534:rehabilitation / Q000628:therapy; D017719:Diabetic Foot / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D057510:Endovascular Procedures / Q000009:adverse effects / Q000639:trends; D019317:Evidence-Based Medicine; D005528:Foot / Q000098:blood supply* / Q000473:pathology / Q000601:surgery; D005734:Gangrene; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000503:physiopathology / Q000534:rehabilitation / Q000628:therapy; D007866:Leg / Q000098:blood supply* / Q000473:pathology / Q000601:surgery; D023821:Limb Salvage / Q000009:adverse effects / Q000639:trends; D057285:Precision Medicine; D012008:Recurrence; D012039:Regional Blood Flow; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects / Q000639:trends; D058017:Vascular Grafting / Q000009:adverse effects / Q000639:trends
keywords: PAD in diabetes; angioplasty; critical limb ischaemia; diabetic foot ulcer; limb-threatening ischaemia; lower extremity bypass; revascularization