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Lower limb ischaemia in patients with diabetic foot ulcers and gangrene: recognition, anatomic patterns and revascularization strategies
Author(s) -
Mills Joseph L.
Publication year - 2016
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.2753
Subject(s) - medicine , gangrene , asymptomatic , amputation , diabetes mellitus , ischemia , diabetic foot , critical limb ischemia , revascularization , cardiology , ankle , foot (prosody) , peripheral , surgery , perfusion , kidney disease , myocardial infarction , linguistics , philosophy , endocrinology
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 © 2016 John Wiley & Sons, Ltd.