Lower limb revascularization in diabetics

Treatment of critical lower limb ischemia in diabetics is often a complex clinical problem for the diabetics' general condition and the local condition of the territory to be revascularized. For these reasons, often the only treatment for diabetics with ischemic-necrotic lesions is amputation. In the symptomatology of arterial disease in diabetics there are three stages: claudication, rest pain, ulcerative-necrotic lesions and two treatment modalities: conservative treatment and revascularization. Conservation is based on the optimization of metabolic control, correction of anemia, control of risk factors, removal of necrotic areas, specific antibiotic treatment based on culture tests. No healing of ulcerative-necrotic lesions after a reasonable period of optimum therapy, quantified in 6 weeks, is suggestive for the presence of absolute or relative ischemia and diagnostic angiography is suitable for the indication for intravascular or surgical revascularization. The latter, in case of diabetics with ischemic complications of the foot, is performed in specialized centers with inverted saphenous veins or in situ in the supragenicular and subgenicular district. Recently intravascular revascularization with balloons, atherotomes, stents, less invasive and less traumatic than bypass revascularization, have become available. At present, with peripheral revascularization, limb salvage at 5-years is feasible in 92% of diabetics with critical lower extremity ischemia.