Table 1: Suggested frequency for Follow-UP Evaluation
Peripheral Arterial Disease (PVD) and the DFU
- We suggest that patients with diabetes have ankle- brachial index (ABI) measurements performed when they have reached 50 years of age.
- We suggest that patients with diabetes who have a prior history of DFU, prior intervention for peripheral vascular disease, or known atherosclerotic cardiovascular disease (eg. Coronary, cerebra, or renal) have an annual vascular examination of the lower extremities and feet including ABI and toe pressures.
- We recommend that patients with DFU have pedal perfusion assessed by ABI, ankle and pedal Doppler arterial waveforms, and either toe systolic pressure or transcutaneous oxygen pressure (TcPO2)
- In patients with DFU who have PAD, we recommend revascularization by either surgical bypass or endovascular therapy.
Technical and implementation Remarks
- Prediction of patients most likely to require and to benefit from revascularization can be based on the Society of Vascular Surgery (SVS) Wound, Ischemia, and foot infection (Wifi) lower extremity threatened limb classification. (See Table 2).
- A combination of clinical judgement and careful interpretation of objective assessments of perfusion along with consideration of the wound and infection extent is required to select patients appropriately for revascularization.
- In functional patients with long- segment occlusive disease and a good autologous conduit, bypass is likely to be preferable.
- In the setting of tissue loss and diabetes, prosthetic bypass is inferior to bypass with vein conduit.
- The choice of intervention depends on the degree of ischemia, the extent of arterial disease, the extent of the wound, the presence of absence of infection, and the available expertise.