Advanced

The ulcerated leg: when to revascularize

Apelqvist, Jan LU and Lepantalo, M. J. A. (2012) In Diabetes/Metabolism Research Reviews 28(Suppl. 1). p.30-35
Abstract
The role of peripheral arterial disease in ulcerated diabetic feet has long been underestimated. Progressive claudication, rest pain and the extent of irreversible tissue loss have frequently been indications for revascularization for neuroischaemic ulcers in diabetic patients. These typical ischaemic symptoms are warning signs that are less frequent in diabetic individuals with ischaemia than those without diabetes. Consequently, 30-50% of individuals with diabetes and foot ulcers already have gangrene at admission and are therefore often considered unsuitable for revascularization. Furthermore, the healing of a neuroischaemic ulcer is worsened by microvascular dysfunction, causing arteriovenous shunting, capillary ischaemia, leakage and... (More)
The role of peripheral arterial disease in ulcerated diabetic feet has long been underestimated. Progressive claudication, rest pain and the extent of irreversible tissue loss have frequently been indications for revascularization for neuroischaemic ulcers in diabetic patients. These typical ischaemic symptoms are warning signs that are less frequent in diabetic individuals with ischaemia than those without diabetes. Consequently, 30-50% of individuals with diabetes and foot ulcers already have gangrene at admission and are therefore often considered unsuitable for revascularization. Furthermore, the healing of a neuroischaemic ulcer is worsened by microvascular dysfunction, causing arteriovenous shunting, capillary ischaemia, leakage and venous pooling. Therefore, the threshold of revascularizing neuroischaemic ulcers should be lower than that of purely ischaemic ulcers. Comorbidity, ulcer characteristics and infection affect the decision as to when to intervene, as do the severity and extent of occlusive arterial lesions. The window of opportunity for vascular intervention in the neuroischaemic diabetic foot should not be missed, and the need for early vascular intervention as an integrated part of a strategy to achieve healing should be emphasized. Noninvasive vascular testing should be performed on all individuals with an ulcerated diabetic foot. The arterial tree should be imaged if noninvasive tests indicate ischaemia or when mild or questionable ischaemia is diagnosed and conservative treatment does not promote ulcer healing in 6 weeks. Revascularization should be performed whenever feasible to repair distal perfusion to achieve ulcer healing. Copyright (C) 2012 John Wiley & Sons, Ltd. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
diabetic foot, nonhealing ulcer, ischaemia, neuroischaemia, impaired, perfusion, revascularization
in
Diabetes/Metabolism Research Reviews
volume
28
issue
Suppl. 1
pages
30 - 35
publisher
John Wiley & Sons
external identifiers
  • wos:000299377700007
  • pmid:22271720
  • scopus:84856193878
ISSN
1520-7552
DOI
10.1002/dmrr.2259
language
English
LU publication?
yes
id
af699266-9a0b-49fe-92d7-dbd4d6869259 (old id 2348790)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22271720?dopt=Abstract
date added to LUP
2012-03-01 11:24:40
date last changed
2017-05-14 03:18:51
@article{af699266-9a0b-49fe-92d7-dbd4d6869259,
  abstract     = {The role of peripheral arterial disease in ulcerated diabetic feet has long been underestimated. Progressive claudication, rest pain and the extent of irreversible tissue loss have frequently been indications for revascularization for neuroischaemic ulcers in diabetic patients. These typical ischaemic symptoms are warning signs that are less frequent in diabetic individuals with ischaemia than those without diabetes. Consequently, 30-50% of individuals with diabetes and foot ulcers already have gangrene at admission and are therefore often considered unsuitable for revascularization. Furthermore, the healing of a neuroischaemic ulcer is worsened by microvascular dysfunction, causing arteriovenous shunting, capillary ischaemia, leakage and venous pooling. Therefore, the threshold of revascularizing neuroischaemic ulcers should be lower than that of purely ischaemic ulcers. Comorbidity, ulcer characteristics and infection affect the decision as to when to intervene, as do the severity and extent of occlusive arterial lesions. The window of opportunity for vascular intervention in the neuroischaemic diabetic foot should not be missed, and the need for early vascular intervention as an integrated part of a strategy to achieve healing should be emphasized. Noninvasive vascular testing should be performed on all individuals with an ulcerated diabetic foot. The arterial tree should be imaged if noninvasive tests indicate ischaemia or when mild or questionable ischaemia is diagnosed and conservative treatment does not promote ulcer healing in 6 weeks. Revascularization should be performed whenever feasible to repair distal perfusion to achieve ulcer healing. Copyright (C) 2012 John Wiley & Sons, Ltd.},
  author       = {Apelqvist, Jan and Lepantalo, M. J. A.},
  issn         = {1520-7552},
  keyword      = {diabetic foot,nonhealing ulcer,ischaemia,neuroischaemia,impaired,perfusion,revascularization},
  language     = {eng},
  number       = {Suppl. 1},
  pages        = {30--35},
  publisher    = {John Wiley & Sons},
  series       = {Diabetes/Metabolism Research Reviews},
  title        = {The ulcerated leg: when to revascularize},
  url          = {http://dx.doi.org/10.1002/dmrr.2259},
  volume       = {28},
  year         = {2012},
}