Quality of life of a person with Diabetes depends on the Integrity of the micro and macro vascular systems

End organs Heart Brain Kidneys Feet

There are various stages in the presentation of Vascular complications

Healthy feet means? Good perception Healthy skin Soft and pink Pain free walking
Pinjala R K2012

Peripheral vascular disease

Diabetic foot
Circulation deficit Detection & Protection

Prevention & Correction

By
Prof Pinjala R K

Diabetic foot wounds & healing

Circulation in feet
Proximal vessels Distal vessels Small vessels Microvasculature

Doppler / Angiogram / Angioplasty / Bypass / Amputation/ Prosthetic / rehabilitation

Leg Bypass Improves the circulation in the leg/ foot How many would require this operation? How can we detect these pts? How far we can do the bypass? How long it can work? How can we select these patients? How much risk is involved in this bypass? How many still would require an amputation? How much does it cost ? How long one should be in the hospital?

Patient with peripheral vascular disease. Gadoliniumenhanced three-dimensional MR angiogram (MRA). Image from Bowker & Pfiefer: Levin and O'Neal's The Diabetic Foot.

Balloon angioplasty / stenting / atherectomy and others

Angiographic Evaluation of Peripheral Arterial Occlusive Disease and Its Role as a Prognostic Determinant for Major Amputation in Diabetic Subjects With Foot Ulcers - Ezio Faglia, MD, et al

Diabetes Care April 1998 vol. 21 no. 4 625-630

7 segments

Bollinger A: Semi-quantitative assessment of lower limb atherosclerosis from routine angiographic images. Atherosclerosis 38:339346, 1981

Subjects were local residents registered at the Mayo Clinic (Rochester, MN) who met criteria for PAD (A), diabetes (B), or both conditions (C) at the baseline examination (19771978).

Leibson C L et al. Dia Care 2004;27:2843-2849

Copyright 2011 American Diabetes Association, Inc.