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In spite of the most vigorous efforts to intervene medically and surgically when peripheral vascular disease threatens a patient, amputation of the extremity may be the only option left to arrest the progression of the disease. In a previous study, the authors assessed amputations, examined gross pathology, and identified scanning electron microscopic features associated with atherosclerotic disease. In the present study, the authors discuss this disease in terms of conventional light microscopy and transmission electron microscopy.
The publication of the Global Vascular Guidelines in 2019 provide evidence-based, best practice recommendations on the diagnosis and treatment of chronic limb-threatening ischemia (CLTI). Certainly, the multidisciplinary team, and more specifically one with collaborating podiatrists and vascular specialists, has been shown to be highly effective at improving the outcomes of limbs at risk for amputation. This article uses the Guidelines to answer key questions for podiatrists who are caring for the patient with CLTI.
BACKGROUND: Multiple organizations have issued guidelines to address the prevention, diagnosis and management of diabetic foot ulcers. These guidelines are based on evidence review and expert opinion. <p>METHODS: Literature review was conducted and guidelines were reviewed to identify consensus (or lack thereof) on the nature of these recommendations, the strength of the recommendations and the level of evidence.</p> <p>RESULTS: Most guidelines were not based on highest level of evidence (randomized controlled trials). A listing of recommendations for prevention, diagnosis and management was created with evidence basis for all recommendations.</p> <p>CONCLUSIONS: Areas for future research were identified among recommendations based on minimal evidence, areas of controversy, or in areas of clinical care without recommendations.</p>
The timely and accurate noninvasive assessment of peripheral arterial disease is a critical component of a limb preservation initiative in patients with diabetes mellitus. Noninvasive vascular studies can be useful in screening patients with diabetes for peripheral arterial disease. In patients with clinical signs or symptoms, noninvasive vascular studies provide crucial information on the presence, location, and severity of peripheral arterial disease and an objective assessment of the potential for primary healing of an index wound or a surgical incision. Appropriately selected noninvasive vascular studies are important in the decision-making process to determine whether and what type of intervention might be most appropriate given the clinical circumstances. Hemodynamic monitoring is likewise important after either an endovascular procedure or a surgical bypass. Surveillance studies, usually with a combination of physiologic testing and imaging with duplex ultrasound, accurately identify recurrent disease before the occurrence of thrombosis, allowing targeted reintervention. Noninvasive vascular studies can be broadly grouped into three general categories: physiologic or hemodynamic measurements, anatomical imaging, and measurements of tissue perfusion. These types of tests and suggestions for their appropriate application in patients with diabetes are reviewed. (J Am Podiatr Med Assoc 100(5): 406–411, 2010)
Venous Aneurysm of the Dorsal Venous Arch
A Case with an Unusual Etiology
Isolated venous aneurysms of the foot are rare. We report a case of venous aneurysm of the dorsal venous arch of the foot with an unusual traumatic etiology. This is a case report of a female patient with a gradually enlarging swelling on the dorsum of her foot located over the pressure area of her sandal straps. A clinical diagnosis of venous aneurysm was made, and she was treated with surgery. Most cases of superficial venous aneurysms only arouse medical interest, with few cosmetic complaints and no complications. This case is unique because it describes a traumatic venous aneurysm associated with repeated trauma caused by inappropriate footwear. All clinicians and allied health-care professionals involved in podiatric medicine should be aware of this clinical condition in the differential diagnosis of soft-tissue swellings in the feet. (J Am Podiatr Med Assoc 100(2): 143–145, 2010)
Microvascular dysfunction is an important component of the pathologic processes that occur in diabetic foot disease. The endothelial abnormalities observed in patients with diabetes mellitus are poorly understood, and evidence suggests that endothelial dysfunction could be involved in the pathogenesis of diabetic macroangiopathy and microangiopathy. With the advent of insulin replacement in the early 1900s and increased efforts toward metabolic control of diabetes, long-term complications of this disease have become apparent. These late-term complications are primarily disorders of the vascular system. This article reviews the process of microvascular dysfunction and how it may relate to the pathogenesis of diabetic foot problems. (J Am Podiatr Med Assoc 96(3): 245–252, 2006)
