Lower Extremity Revascularization in Diabetes

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Abstract
AWARENESS of the pathophysiological features of vascular disease in diabetes,1-5 coupled with technical advances in extreme distal arterial reconstruction6,7 and an aggressive approach to diabetic foot problems,8-10 has led to improved limb and foot salvage in patients with diabetes.11 Despite this success, there remains a guarded optimism about long-term function and survival in these patients, particularly toward diabetic patients with peripheral arterial disease. Higher rates of lower extremity amputation,12 increased incidence and severity of coronary artery disease,13,14 and higher cardiovascular mortality15 are well-recognized in diabetic patients. The misconception of "diabetic small-vessel disease" has been refuted but still appears in the literature.16 Considered together, these may suggest poorer outcome in treated patients or, even worse, may completely discourage any aggressive treatment in these patients.