IWGDF guidance on the diagnosis, prognosis and management of peripheral artery disease in patients with foot ulcers in diabetes

Abstract

Recommendations1. Examine a patient with diabetes annually for the presence of peripheral artery disease (PAD); this should include, at a minimum, taking a history and palpating foot pulses. (GRADE strength of recommendation: strong; quality of evidence: low) 2. Evaluate a patient with diabetes and a foot ulcer for the presence of PAD.Determine, as part of this examination, ankle or pedal Doppler arterial waveforms; measure both ankle systolic pressure and systolic ankle brachial index (ABI). (strong; low) 3. We recommend the use of bedside non-invasive tests to exclude PAD. No single modality has been shown to be optimal. Measuring ABI (with <0.9 considered abnormal) is useful for the detection of PAD. Tests that largely exclude PAD are the presence of ABI 0.9-1.3, toe brachial index ≥0.75 and the presence of triphasic pedal Doppler arterial waveforms. (strong; low) 4. In patients with a foot ulcer in diabetes and PAD, no specific symptoms or signs of PAD reliably predict healing of the ulcer. However, one of the following simple bedside tests should be used to inform the patient and healthcare professional about the healing potential of the ulcer. Any of the following findings increases the pre-test probability of healing by at least 25%: a skin perfusion pressure ≥40 mmHg, a toe pressure ≥30 mmHg or a transcutaneous oxygen pressure (TcPO 2 ) ≥25 mmHg. (strong; moderate) 5. Consider urgent vascular imaging and revascularisation in patients with a foot ulcer in diabetes where the toe pressure is <30 mmHg or the TcPO 2 <25 mmHg. (strong; low) 6. Consider vascular imaging and revascularisation in all patients with a foot ulcer in diabetes and PAD, irrespective of the results of bedside tests, when the ulcer does not improve within 6 weeks despite optimal management. (strong; low) 7. Diabetic microangiopathy should not be considered to be the cause of poor wound healing in patients with a foot ulcer. (strong; low) 8. In patients with a non-healing ulcer with either an ankle pressure <50 mmHg or ABI <0.5, consider urgent vascular imaging and revascularisation. (strong; moderate) 9. Colour Doppler ultrasound, computed tomography angiography, magnetic resonance angiography or intra-arterial digital subtraction angiography can each be used to obtain anatomical information when revascularisation is

Risco De Úlceras De Membros Inferiores Nos Diabéticos De Um Ambulatório Universitário

“…O tempo médio do diagnóstico do DM foi de 12,9 anos, característico depopulações diabéticas em serviços terciários, comotambém mostrado em outros estudos brasileiros 13,15 . 17,19 . Portanto, seria interessante utilizar outros exames, como a medida da pressão do pododáctilo e cálculo do Índice Dedo Braquial (IDB), para confirmar a real prevalência da associação entre DAP e neuropatia 8,17,18 .…”

“…17,19 . Portanto, seria interessante utilizar outros exames, como a medida da pressão do pododáctilo e cálculo do Índice Dedo Braquial (IDB), para confirmar a real prevalência da associação entre DAP e neuropatia 8,17,18 .…”

Hard-to-heal diabetes-related foot ulcers: current challenges and future prospects

“…91 PAD is an independent baseline predictor of non-healing and also an independent risk factor for both ulcer recurrence and amputation. 89 When caring for patients with DFU, reliably identifying PAD and knowing when to refer and how to provide best management will greatly influence the healing potential of a DFU.…”

Near Infrared Imaging for Angiography in Diabetic Patients With Peripheral Artery Disease

“…В исследование были включены 4 пациента с сахарным диабетом и забо-леваниями артерий нижних конечностей на стадии критической ишемии нижних конечностей. У всех об-следованных диагноз критической ишемии нижних конечностей был установлен согласно критериям IWGDF, 2015 [3]. Для оценки степени ишемии нижних конечностей была проведена транскутанная оксиме-трия с применением транскутанного монитора TCM 400 (Radiometer, Дания).…”