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Review: Peripheral Arterial Disease and Diabetes: A Clinical Update

Microcirculation Laboratory and Joslin-Beth Israel Deaconess Foot Center, Beth Israel Deaconess Medical Center, Harvard Medical School

Sherry Scovell, MD

Massachusetts General Hospital Boston, Massachusetts

Aristidis Veves, MD

Microcirculation Laboratory and Joslin-Beth Israel Deaconess Foot Center, Beth Israel Deaconess Medical Center, Harvard Medical School, aveves{at}bidmc.harvard.edu

Peripheral arterial disease is characterized by a gradual reduction in blood to the extremities secondary to atherosclerosis. In diabetes, the pattern of atherosclerotic occlusion typically shows a propensity toward the infrapopliteal vessels. Additionally, impairment of the microcirculation manifests in diminished vasoreactivity and a functional ischemia that is not always correctable with surgery. However, when a nonhealing wound is complicated by peripheral arterial disease, revascularization is paramount to wound healing. Revascularization can be accomplished through traditional bypass surgery or newer endovascular interventions, such as angioplasty and stenting. These less invasive techniques of revascularization offer the advantages of quicker recovery and lower morbidity but durability may be compromised. Ultimately, the choice of revascularization procedure should be based on the clinical characteristics of the atherosclerotic lesion along with the individual patient history.

Key Words: diabetic foot • peripheral arterial disease • microvascular reactivity

The International Journal of Lower Extremity Wounds, Vol. 8, No. 2, 75-81 (2009)
DOI: 10.1177/1534734609336768


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