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Jan Apelqvist

Physician

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The ulcerated leg: when to revascularize

Author

  • Jan Apelqvist
  • M. J. A. Lepantalo

Summary, in English

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.

Department/s

  • Genomics, Diabetes and Endocrinology

Publishing year

2012

Language

English

Pages

30-35

Publication/Series

Diabetes/Metabolism Research & Reviews

Volume

28

Issue

Suppl. 1

Document type

Journal article

Publisher

John Wiley and Sons

Topic

  • Endocrinology and Diabetes
  • Clinical Medicine

Keywords

  • diabetic foot
  • nonhealing ulcer
  • ischaemia
  • neuroischaemia
  • impaired
  • perfusion
  • revascularization

Status

Published

Research group

  • Genomics, Diabetes and Endocrinology

ISBN/ISSN/Other

  • ISSN: 1520-7552