5
Figure 1. Hemodynamics and Probability of Healing of a
Diabetic Foot Ulcer
Adapted from: http://www.jvascsurg.org/article/S0741-5214(10)01333-9/pdf
CA Andersen. Noninvasive assessment of lower extremity hemodynamics in individuals
with diabetes mellitus. J Vasc Surg. 2010;52(Suppl):76S-80S.
Technical and Implementation Remarks
➤ Prediction of patients most likely to require and to benefit from
revascularization can be based on the Society for Vascular Surgery
(SVS) Wound, Ischemia, and foot Infection (WIfI) lower extremity
threatened limb classification. (See Table 2)
➤ A combination of clinical judgment and careful interpretation of
objective assessments of perfusion along with consideration of the
wound and infection extent is required to select patients appropriately
for revascularization.
➤ In functional patients with long-segment occlusive disease and a good
autologous conduit, bypass is likely to be preferable.
➤ In the setting of tissue loss and diabetes, prosthetic bypass is inferior
to bypass with vein conduit.
➤ The choice of intervention depends on the degree of ischemia, the
extent of arterial disease, the extent of the wound, the presence or
absence of infection, and the available expertise.
