PERIPHERAL ARTERIAL OCCLUSIVE DISEASE

                                       PERIPHERAL ARTERIAL OCCLUSIVE DISEASE

Peripheral Arterial Occlusive Disease

Peripheral arterial occlusive disease is four times more prevalent in diabetics than in non-diabetics.The arterial occlusion typically involves the tibial and peroneal arteries but spares the dorsalis pedis artery. Smoking, hypertension and hyperlipidemia commonly contribute to the increased prevalence of peripheral arterial occlusive disease in diabetics.
The presence of lower extremity ischemia is suggested by a combination of clinical signs and symptoms plus abnormal results on noninvasive vascular tests. Signs and symptoms may include claudication, pain occurring in the arch or forefoot at rest or during the night, absent popliteal or posterior tibial pulses, thinned or shiny skin, absence of hair on the lower leg and foot, thickened nails, redness of the affected area when the legs are dependent, or “dangled,” and pallor when the foot is elevated.
Noninvasive vascular tests include transcutaneous oxygen measurement.
 The ankle-brachial index (ABI) and the absolute toe systolic pressure.


The ABI is a noninvasive test that can be performed easily in the office using a handheld Doppler device. A blood pressure cuff is placed on the upper arm and inflated until no brachial pulse is detected by the Doppler device. The cuff is then slowly deflated until a Doppler-detected pulse returns (the systolic pressure). This maneuver is repeated on the leg, with the cuff wrapped around the distal calf and the Doppler device placed over the dorsalis pedis or posterior tibial artery. The ankle systolic pressure divided by the brachial systolic pressure gives the ABI.
The sensitivity and specificity of noninvasive vascular tests are a matter of some controversy. Commonly accepted abnormal values for transcutaneous oxygen measurement.
The noninvasive tests have been faulted for underestimating the severity of arterial insufficiency.
 If lower extremity ischemia is strongly suspected, arteriography or some other imaging study should be performed to confirm or rule out ischemia.

Optimal ulcer healing requires adequate tissue perfusion. Thus, arterial insufficiency should be suspected if an ulcer fails to heal. Vascular surgery consultation and possible revascularization should be considered when clinical signs of ischemia are present in the lower extremity of a diabetic patient and the results of noninvasive vascular tests or imaging studies suggest that the patient has peripheral arterial occlusive disease.
Proper control of concomitant hypertension or hyperlipidemia can help to reduce the risk of peripheral arterial occlusive disease. Smoking cessation is essential for preventing the progression of occlusive disease.