Comprehensive Assessment of Current Management Strategies for Patients With Diabetes and Chronic Limb-Threatening Ischemia

Abstract

Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral artery disease. It is estimated that 60% of all nontraumatic lower-extremity amputations performed annually in the United States are in patients with diabetes and CLTI. The consequences of this condition are extraordinary, with substantial patient morbidity and mortality and high socioeconomic costs. Strategies that optimize the success of arterial revascularization in this unique patient population can have a substantial public health impact and improve patient outcomes. This article provides an up-to-date comprehensive assessment of management strategies for patients afflicted by both diabetes and CLTI.

Approaches to Peripheral Artery Disease in Diabetes: Are There Any Differences?

“…The contemporary approach to these infrapopliteal lesions has been improved by the dual vascular approach [ 36 ] and the use of drug-eluting balloons [ 37 ]. Recent studies suggest an additional benefit in treating infrapopliteal lesions in patients with diabetes and chronic limb-threatening ischemia with paclitaxel-eluting balloons [ 38 ].…”

“…DM may adversely affect peripheral stent restenosis and target lesion revascularization [ 39 , 40 ]. It has also been shown that adults with PAD and concomitant DM exhibited worse lower extremity function than those who were only diagnosed with PAD [ 37 ]. Impaired lower extremity function is an important predictor of future incapacity, including the loss of mobility and placement in a rehabilitation center.…”

“…Impaired lower extremity function is an important predictor of future incapacity, including the loss of mobility and placement in a rehabilitation center. As a result, a patient with DM and PAD demonstrates a high-risk clinical profile that should be evaluated for comorbidities such as neuropathy, foot ulceration, or concurrent coronary artery disease, which could contribute to incapacity and disability [ 37 ]. A diabetic patient is polyarterial, meaning that the deleterious processes of glycosylation do not spare the coronary, carotid, or cerebral arteries [ 41 , 42 ].…”

Diabetes and Its Cardiovascular Complications: Comprehensive Network and Systematic Analyses

“…Concerning the lower extremity amputation risk, advanced PAD can result in chronic limb threatening ischemia (CLTI) which is associated with a higher risk of lower limb loss ( 229 ). Since amputation risk of lower extremities is a common complication of patients with PAD and diabetes ( 230 ), it is important to be able to assess PAD risk among diabetic patients before they develop diabetic foot ulcers in which amputation then becomes more necessary.…”