Abstract

Integrated management of the diabetic ischemic foot

Author(s): Alberto Piaggesi & Lanfroi Graziani

Ischemia represents the most important determinant for major amputation in the diabetic foot, and is associated with a higher prevalence of foot infections, systemic comorbidity and mortality. Until recently, prognosis for these patients was very poor; however, despite solid population-based evidence not being presently available, there are still indications that the introduction of both endovascular and surgical revascularization has improved prognosis. Improvements in the materials, technology and procedures in the last 10 years, as well as increasing experience, suggest that revascularization should no longer be considered a limb-saving option, but instead, a first-line intervention with a wide range of indications in the ischemic diabetic foot. This approach, when integrated into a therapeutic strategy that includes both local surgery and systemic medical management and applied in highly specialized centers, allows high healing rates with a significant reduction of major amputations.