The influence of diabetes mellitus upon peripheral vascular disease

The treatment of 332 consecutive patients referred to a peripheral vascular unit with rest pain, ulceration or gangrene of the lower limb has been studied. Ninety-seven (20 per cent) of the patients had diabetes mellitus. Although diabetes was related to adverse limb salvage and patient survival rates, this could be accounted for by the influence of initial presenting clinical features and treatment upon survival time. The influence of these factors upon survival time was still strong even when the data were stratified for diabetric status. Thus, an extensive amputation carries the worse prognosis, with a less extensive amputation intermediate between an extensive amputation and any other form of therapy. Patients with both rest pain and ulceration or gangrene have a poor prognosis when assessed by either limb salvage or mortality. The majority of the patients with less extensive amputations are diabetic. This is related to the high incidence of localized ulceration among those in the diabetic group. In diabetics, a less extensive amputation, if clinically indicated, is worthwhile because of the low incidence of a subsequent extensive amputation after a less extensive amputation and the better survival rate for those patients with less extensive amputations as compared with those with extensive amputations.