The patient presenting with chronic limb-threatening ischaemia. Does diabetes influence presentation, limb outcomes and survival?

Robert Fitridge, Guilherme Pena, Joseph L. Mills

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Peripheral arterial disease (PAD) confers an elevated risk of major amputation and delayed wound healing in diabetic patients with foot ulcers. The major international vascular societies recently developed evidence-based guidelines for the assessment and management of patients with chronic limb-threatening ischaemia (CLTI). CLTI represents the cohort of diabetic and non-diabetic patients who have PAD which is of sufficient severity to delay wound healing and increase amputation risk. Diabetic patients with CLTI are more likely to present with tissue loss, infection and have less favourable anatomy for revascularization than those without diabetes. Although diabetes is not consistently reported as a strong independent risk factor for limb loss, major morbidity and mortality in CLTI patients, it is impossible in clinical practice to isolate diabetes from comorbidities, such as end-stage renal disease and coronary artery disease which occur more commonly in diabetic patients. Treatment of CLTI in the diabetic patient is complex and should involve a multi-disciplinary team to optimize outcomes. Clinicians should use an integrated approach to management based on patient risk assessment, an assessment of the severity of the foot pathology and a structured anatomical assessment of arterial disease as suggested by the Global Vascular Guidelines for CLTI.

Original languageEnglish (US)
Article numbere3242
JournalDiabetes/Metabolism Research and Reviews
Volume36
Issue numberS1
DOIs
StatePublished - Mar 1 2020
Externally publishedYes

Keywords

  • amputation
  • chronic limb-threatening ischaemia
  • diabetic foot infection
  • foot perfusion
  • WIfI
  • wound healing

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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