Chapter 5: Chronic Lower Limb Ischaemia, Critical Ischaemia and the Diabetic Foot

The following sections are included:

• Peripheral arterial disease (PAD) affects approximately 30% of the adult population.

• PAD is a powerful marker of cardiovascular risk and the risk is related to the severity of PAD.

• Risk factor management has been proven to reduce cardiovascular risk, but many patients do not receive adequate treatment.

• The optimum treatment to improve walking in patients with intermittent claudication is best medical treatment (BMT) and supervised exercise, with angioplasty for those who do not improve with exercise therapy.

• Angioplasty and surgery appear to be equivalent in treating critical limb ischaemia (CLI), but there is insufficient evidence comparing long-term outcomes. Angioplasty is cheaper due to reduced length of hospital stay, but surgery is better for patients who survive over 2 years. There is some evidence that patients have worse outcomes if they undergo surgery after having endovascular intervention.

• Diabetic foot complications are a common cause of hospital admission and often precede amputation. The majority of amputations in the UK are carried out in patients with diabetes, and many of these are avoidable.

• Patients with diabetes should be screened annually for neuropathy and PAD and those at increased risk of foot ulceration seen regularly in a specialised foot clinic.

• Multi-professional team approach to the management of diabetic foot complications and timely recognition and treatment of the acute diabetic foot can reduce amputation rates.