Diagnosis of Peripheral Artery Disease in the Diabetic Patient
Peripheral artery disease (PAD) affects over 200 million patients globally. Patients with diabetes have a twofold higher risk of developing PAD, and with this comes a higher rate of foot ulceration and amputation. The prompt diagnosis and treatment of PAD in diabetic foot ulcer patients is of paramount importance to wound healing and limb preservation. This chapter will outline key features of the initial evaluation for PAD in patients with diabetes. It will also describe the various noninvasive diagnostic modalities available for use, along with their advantages and disadvantages.
KeywordsPeripheral arterial disease Diabetic limb salvage Foot ulceration Noninvasive arterial testing Doppler segmental pressures Toe pressures Doppler waveform analysis Pulsed volume recordings Duplex ultrasound Transcutaneous oxygen tension Laser Doppler perfusion
- 11.Boulton AJ, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care. 2008;31:1679–85.CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Lin JS, Olson CM, Johnson ES, Senger CA, Soh CB, Whitlock EP, U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews. The Ankle Brachial Index for Peripheral Artery Disease Screening and Cardiovascular Disease Prediction in Asymptomatic Adults: A Systematic Evidence Review for the US Preventive Services Task Force. Rockville, MD: Agency for Healthcare Research and Quality (US); 2013.Google Scholar
- 25.Daigle RJ. Techniques in noninvasive vascular diagnosis. 3rd ed. Littleton, CO: Summer Publishing, LLC; 2008.Google Scholar
- 31.Padberg FT Jr, Back TL, Hart LC, Franco CD. Comparison of heated-probe laser Doppler and transcutaneous oxygen measurements for predicting outcome of ischemic wounds. J Cardiovasc Surg. 1992;33:715–22.Google Scholar
- 39.Stacy MR, Qiu M, Papademetris X, Caracciolo CM, Constable RT, Sinusas AJ. Application of BOLD magnetic resonance imaging for evaluating regional volumetric foot tissue oxygenation: a feasibility study in healthy volunteers. Eur J Vasc Endovasc Surg. 2016;51:743–9.CrossRefPubMedPubMedCentralGoogle Scholar