Skip to main content

Modern Concepts of Vascular and Microvascular Disease in Diabetes Mellitus: Implications for Limb Salvage

  • Conference paper
Modern Vascular Surgery

Abstract

Foot problems are one of the most common reasons for hospitalization of patients with diabetes mellitus. The incidence of major amputation is approximately 1% per year for the diabetic population over the age of 65.1 Ischemia, often in combination with neuropathy and infection, is a major factor in the pathogenesis of diabetic foot problems. The purpose of this article is to describe the mechanisms leading to ischemia and to provide a plan for optimum clinical management.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bild DE, Selby JV, Sinnock P, Browner WS, Braveman P, Showstack JA. Lower-extremity amputation in people with diabetes. Epidemiology and prevention. Diabetes Care 1989;12:24–31.

    Article  PubMed  CAS  Google Scholar 

  2. LoGerfo FW, Coffman JD. Vascular and microvascular disease of the foot in diabetes: Implications for foot care. N Engl J Med 1984;311:1615–1619.

    Article  PubMed  CAS  Google Scholar 

  3. Strandness DE Jr, Priest RE, Gibbons GE. Combined clinical and pathologic study of diabetic and nondiabetic peripheral arterial disease. Diabetes 1964;13:366–372.

    PubMed  Google Scholar 

  4. Conrad MC. Large and small artery occlusion in diabetics and nondiabetics with severe vascular disease. Circulation 1967;36:83–91.

    PubMed  CAS  Google Scholar 

  5. Barner HB, Kaiser GC, Willman VL. Blood flow in the diabetic leg. Circulation 1971;43:391–394.

    PubMed  CAS  Google Scholar 

  6. Irwin ST, Gilmore J, McGrann S, Hood J, Allen JA. Blood flow in diabetics with foot lesions due to’ small vessel disease’. Br J Surg 1988;75:1201–1206.

    Article  PubMed  CAS  Google Scholar 

  7. Parving HH, Rasmussen SM. Transcapillary escape rate of albumin and plasma volume in short-and long-term juvenile diabetes. Scand J Clin Lab Invest 1973;32:81–87.

    Article  CAS  Google Scholar 

  8. Wyss CR, Matsen FA, Simmons CW, Burgess EM. Transcutaneous oxygen tension measurements on limbs of diabetic and nondiabetic peripheral vascular disease. Diabetes 1964;13:366–372.

    Google Scholar 

  9. Fagrell B, Hermansson IL, Karlander SG, Ostergren J. Vital capillary microscopy for assessment of skin viability and microangiopathy in patients with diabetes mellitus. Acta Medica Scandinavica 1984;687:25–28.

    PubMed  CAS  Google Scholar 

  10. Beach KW, Bedford GR, Bergelin RO, Martin DC, Vandenberghe N, Zaccardi M, Strandness DE. Progression of lower-extremity arterial occlusive disease in type II diabetes mellitus. Diabetes Care 1988;11:464–472.

    Article  PubMed  CAS  Google Scholar 

  11. Menzoian JO, LaMorte WW, Paniszyn CC, McBride KJ, Sidawy AN, LoGerfo FW, Connors ME, Doyle JE. Symptomatology and anatomic patterns of peripheral vascular disease: Differing impact of smoking and diabetes. Ann Vasc Surg 1989;3:224–228.

    Article  PubMed  CAS  Google Scholar 

  12. Apelqvist J, Castenfors J, Larsson J, Stenstrom A, Agardh C-D. Prognostic value of systolic ankle and toe blood pressure levels in outcome of diabetic foot ulcer. Diabetes Care 1989;12:373–378.

    Article  PubMed  CAS  Google Scholar 

  13. Parfrey PS, Griffiths SM, Barrett BJ, Paul MD, Genge M, Withers J, Farid N, McManamon PJ. Contrast material-induced renal failure in patients with diabetes mellitus, renal insufficiency, or both. A prospective controlled study. N Engl J Med 1989;320:143–149.

    Article  PubMed  CAS  Google Scholar 

  14. Stacul F, Carraro M, Magnald S, Faccini L, Guarnieri G, Dalla Palma L. Contrast agent nephrotoxicity: comparison of ionic and nonionic contrast agents. Am J Roentgenol 1987;149:1287–1289.

    CAS  Google Scholar 

  15. Gibbons GW. The diabetic foot: amputations and drainage of infection. J Vasc Surg 1987;5:791–793.

    PubMed  CAS  Google Scholar 

  16. Hurley JJ, Auer AI, Hershey FB, Binnington HB, Woods JJ, Nunnelee JD, Milyard MK. Distal arterial reconstruction: Patency and limb salvage in diabetics. J Vasc Surg 1987;5:796–800.

    Article  PubMed  CAS  Google Scholar 

  17. Sidawy AN, Menzoian JO, Cantelmo NL, LoGerfo FW. Effect of inflow and outflow sites on the results of tibioperoneal vein grafts. Am J Surg 1986;152:211–214.

    Article  PubMed  CAS  Google Scholar 

  18. Rosenblatt MS, Quist WC, Sidawy AN, Paniszyn CC, LoGerfo FW. Lower extremity vein graft reconstruction: Results in diabetic and non-diabetic patients. Surg Gynecol Obstet 1990;171:331–335.

    PubMed  CAS  Google Scholar 

  19. Pomposelli FB, Jepsen SJ, Gibbons GW, Campbell DR, Freeman DV, Miller A, LoGerfo FW. Efficacy of the dorsalis pedis bypass for limb salvage in diabetic patients. J Vasc Surg 1990;11:745–752.

    PubMed  Google Scholar 

  20. Cantelmo NL, Snow JR, Menzoian JO, LoGerfo FW. Successful vein bypass in patients with an ischemic limb and palpable popliteal pulse. Arch Surg 1986;121:217–220.

    PubMed  CAS  Google Scholar 

  21. Pomposelli FB Jr, Jepsen SJ, Gibbons GW, Campbell DR, Freeman DV, Gaughan BM, Miller A, LoGerfo FW. A flexible approach to infra-popliteal vein grafts in patients with diabetes mellitus. Arch Surg (in press).

    Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1992 Springer-Verlag New York Inc.

About this paper

Cite this paper

LoGerfo, F.W., Pomposelli, F.B. (1992). Modern Concepts of Vascular and Microvascular Disease in Diabetes Mellitus: Implications for Limb Salvage. In: Chang, J.B. (eds) Modern Vascular Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-2946-9_31

Download citation

  • DOI: https://doi.org/10.1007/978-1-4612-2946-9_31

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-7731-6

  • Online ISBN: 978-1-4612-2946-9

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics