Lower limb ischemia

Diabetes mellitus is the major cause of nontraumatic amputations in the industrialized countries. In 1980 the scientific societies of diabetology and the patients' associations subscribed at St. Vincent a declaration together with the WHO, where a 50% decrease in amputations was among the primary objectives of clinical diabetology. The main cause of amputations is foot ischemia related to obliterating peripheral arterial disease, more diffuse and severe in diabetics, typically affecting the infrapopliteal vessels. Clinical patterns of foot ischemia include superficial necrotic areas and gangrene involving the entire foot with necrosis of all anatomic planes. Infection is a common complication with a negative impact on prognosis. Definitive treatment of ischemia is achieved with revascularization which at present due to the advances in diagnostic procedures can be performed in diabetics with the same effectiveness observed in non diabetics.