With the crucial role played in the healing of diabetic foot ulcers, assessment of presence or absence of peripheral artery disease is crucial.
This can, however, be difficult because of the often complex, diffuse and distal nature of peripheral artery disease in patients with diabetes, as well as poor collateralisation and heavy vascular calcification. Dr. Forsythe and Prof. Hinchliffe outline the various conventional and newer methods to assess tissue perfusion, describing the (dis)advantages associated with each.
However, their final conclusion highlights the difficulties we are still facing in the clinic, since “All of the commonly available techniques have limitations, particularly relating to the complexity of diabetes […] The assessment of perfusion in patients with diabetes therefore remains a challenge.” Thus, they stress the importance of comprehensive assessment, combining different methods.
It is a challenge we need to face, since it will direct appropriate treatment. When such treatment is needed, both endovascular and open procedures should be considered, as well as the option of not pursuing surgical treatment. Choices in relation to these treatments are described by Prof. Mills, who concludes that “The vascular specialist or limb salvage team providing comprehensive care for patients with this condition should be competent in both endovascular and open procedures, so that therapy can be unbiased and objectively tailored to a given patient’s situation.”