- New guidelines from the International Working Group on the Diabetic Foot address diagnosis and management of peripheral artery disease (PAD) in patients with foot ulcers and diabetes.
Why this matters
- Up to 50% of patients with diabetes and foot ulceration have concurrent PAD, which raises morbidity risks.
- Examine feet of all patients with diabetes annually for PAD, even without ulceration, via history and palpating foot pulses.
- For those with foot ulcers, evaluate pedal Doppler arterial waveforms, ankle systolic pressure, systolic ankle-brachial index (ABI), or toe systolic pressure and toe-brachial index (TBI).
- PAD is less likely with:
- ABI 0.9-1.3,
- TBI ≥0.75, and
- Triphasic pedal Doppler waveforms.
- Perform ≥1 of the following bedside tests in patients with diabetic foot ulcers and PAD, all of which increase pretest healing probability by ≥25%:
- Skin perfusion pressure ≥40 mmHg,
- Toe pressure ≥30 mmHg, or
- Transcutaneous oxygen pressure (TcPO2) ≥25 mmHg.
- Consider urgent vascular imaging and revascularization in patients with foot ulcer and:
- Ankle pressure
- Toe pressure
- Provide intensive cardiovascular risk management, including smoking cessation support, and treatment of hypertension, hyperglycemia, dyslipidemia, and use of low-dose clopidogrel or aspirin.