ABSTRACT
Lower extremity peripheral vascular disease (PVD) is among the most important reasons for disabling pain, nonhealing ulcerations, and amputation in individuals with and without diabetes. The incidence of PVD in diabetic patients is at least ten times that of nondiabetics and increases with age and duration of diabetes. PVD results in decreased arterial perfusion to the lower extremity and foot. It contributes to pain, limb ulceration, impaired wound healing, and decreases the ability to fight infection by delaying or preventing the delivery of oxygen, nutrients, the components of a proper immune response, and antibiotics to the infected area. Pecoraro and colleagues noted that critical ischemia was associated with 62% of cases in whom there was nonhealing ulceration and was a causal factor in 46% of amputations. Unrecognized or untreated PVD increases the risk for amputation. The purpose of this chapter is to review the signs, symptoms, evaluation, and therapies for PVD to help the primary care physician in his day-today management of diabetic patients. The bottom line: "modern revascularization procedures offer great hope to diabetic patients with limb-threatening ischemia and should be considered before any thought of amputation."
