Peripheral Vascular Disease in Patients with Diabetes Mellitus

  • Allen D. Hamdan
  • Frank B. PomposelliJr.
  • Gary W. Gibbons
  • Frank W. LoGerfo
Part of the Contemporary Cardiology book series (CONCARD)


The pattern of atherosclerotic occlusion commonly found with diabetes involves the tibial and peroneal arteries but spares both the superficial femoral artery as well as the arteries of the foot, especially the dorsalis pedis artery (1). In general, patients without diabetes tend to have more proximal disease affecting the femoral arteries, often at the adductor hiatus. The propensity toward tibial/peroneal involvement (crural disease) in diabetes mellitus was noted in prospective studies of amputation specimens (2) and more recently by arteriography (3). One of the early impediments to extreme distal reconstruction in diabetes probably resulted from the initial suggestions that there was an occlusive lesion in the microcirculation that would prevent tissue perfusion (4). All the subsequent prospective studies have failed to confirm the existence of such a lesion. Noninvasive vascular evaluation of diabetic and nondiabetic patients presenting with foot ulceration confirmed that there was no evidence of higher vascular resistance (5). With this understanding of vascular disease in mind, therefore, it is logical to extend arterial reconstruction to the arteries below the knee, especially the dorsalis pedis artery in patients with diabetes. In general, after vascular reconstruction, the foot is more resistent to recurrent ulceration, and can withstand and recover from infections better.


Peripheral Vascular Disease Vein Graft Limb Salvage Popliteal Artery Superficial Femoral Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Conrad MC. Large and small artery occlusion in diabetics and nondiabetics with sever vascular disease. Circulation 1967;36:83–91.PubMedCrossRefGoogle Scholar
  2. 2.
    Strandness DE Jr, Priest RE, Gibbons GE. Combined clinical pathological study of diabetic and nondiabetic peripheral arterial disease. Diabetes 1964;13:366–372.PubMedGoogle Scholar
  3. 3.
    Menzoian JO, Lamorte WW, Paniszyn CC, et al. Symptomatology and anatomic patterns of peripheral vascular disease: differing impact of smoking and diabetes. Ann Vasc Surg 1989;3:224–228.Google Scholar
  4. 4.
    Goldenberg SG, Alex M, Joshi RA, Blumenthal HT. Nonatheromatous peripheral vascular disease of the lower extremity in diabetes mellitus. Diabetes 1959;8:261–273.PubMedGoogle Scholar
  5. 5.
    Irwin ST, Gilmore J, McGrann S, et al. Blood flow in diabetics with foot lesions due to small vessel disease. Br J Surg 1988;75:1201–1206.PubMedCrossRefGoogle Scholar
  6. 6.
    Siperstein MD, Unger RH, Madison LL. Studies of muscle capillary basement membranes in normal subjects, diabetic and prediabetic patients. J Clin Invest 1968;47:1973–1999.PubMedCrossRefGoogle Scholar
  7. 7.
    Brownlee M, Cerami IA, Vlassara H. Advanced glycosylation end products in tissue and the biochemical basis of diabetic complications. N Engl J Med 1988;318:1315–1321.PubMedCrossRefGoogle Scholar
  8. 8.
    Wyss CR, Matsen FA, Simmons CW, et al. Transcutaneous oxygen tension measurements on limb of diabetic and nondiabetic vascular disease. Diabetes 1964;13:366–372.Google Scholar
  9. 9.
    Katz MA, McNeill G. Defective vasodilation response to exercise in cutaneous precapillary vessels in diabetic humans. Diabetes 1987;36:1386–1396.PubMedCrossRefGoogle Scholar
  10. 10.
    Blakeman BM, Littooy FM, Baker WH. Intra-arterial digital subtraction angiography as a method to study peripheral vascular diseases. J Vasc Surg 1986;4:168–173.PubMedGoogle Scholar
  11. 11.
    Veith FJ, Gupta SK. Samson RH, et al. Progress in limb salvage by reconstructive arterial surgery combined with new or improved adjunctive procedure. Ann Surg 1981;194:386–401.Google Scholar
  12. 12.
    Leather RP, Powers SR, Karmody AM. A reappraisal of the in situ saphenous vein arterial bypass: its use in limb salvage. Surgery 1979;86:453–461.PubMedGoogle Scholar
  13. 13.
    Thompson RW, Mannick JA, Whittemore AD. Arterial reconstruction at divers sites using nonreversed autogenous vein. Ann Surg 1987;205:747–751.PubMedCrossRefGoogle Scholar
  14. 14.
    Veith FJ, Gupta SK, Samson RH, Flores SW, Janko G, Scher LA. Superficial femoral and popliteal arteries as inflow site for distal bypasses. Surgery 1981;90:980–990.PubMedGoogle Scholar
  15. 15.
    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;152:211–224.PubMedCrossRefGoogle Scholar
  16. 16.
    Plecha EJ, Seabrook GR, Bandyk DF, Towne JB. Determinants of successful peroneal artery bypass. J Vasc Surg 1993;17:97–106.PubMedCrossRefGoogle Scholar
  17. 17.
    Schneider JR, Walsh DB, McDaniel MD, Zwolek RM, Besso SR, Cronenwett JL. Pedal bypass versus tibial bypass with autogenous vein: a comparison of outcome and hemodynamic results. J Vasc Surg 1993:17:1029–1040.PubMedCrossRefGoogle Scholar
  18. 18.
    Tannebaum GA, Pomposelli FB Jr, Marcaccio EJ, et al. Safety of vein bypass grafting to the dorsalis pedis artery in diabetic patients with foot infections. J Vasc Surg 1992;15:982–988.CrossRefGoogle Scholar
  19. 19.
    Pomposelli FB Jr, Marcaccio EJ, Gibbons GW, et al. Dorsalis pedis arterial bypass: durable limb salvage for foot ischemia in patients with diabetes mellitus. J Vasc Surg 1995; 21:35–45.PubMedCrossRefGoogle Scholar
  20. 20.
    LoGerfo FW, Gibbons GW, Pomposelli FB Jr, et al. Trends in the care of the diabetic foot: expanded role of arterial reconstruction. Arch Surg 1992;127:617–621.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Allen D. Hamdan
  • Frank B. PomposelliJr.
  • Gary W. Gibbons
  • Frank W. LoGerfo

There are no affiliations available

Personalised recommendations