Surgical Revascularisation of the Diabetic Foot

The presence of lower limb peripheral arterial disease (PAD) is one of the major causes of non-healing foot ulcers and eventually loss of limb in diabetic patients. Investigation and treatment of PAD should be performed without delay if limb salvage is desired. The goal of lower limb revascularisation in the diabetic patient is to heal any tissue loss secondary to ischaemia, thus achieving limb salvage and restoration of limb function together with preservation of the patient’s quality of life. Revascularisation can be performed via an endovascular approach or with surgical bypass. Investigations for PAD and techniques for revascularisation are outlined in this chapter. Ankle brachial pressure index (ABPI) assessment, transcutaneous oximetry (TCpO2) recordings, duplex scanning and other non-invasive and invasive methods of investigating and imaging the diabetic patient with lower limb PAD are discussed. The indications, techniques, risks and outcomes of intervention for PAD in the diabetic foot patient are also outlined.