Diabetisches Fusssyndrom: Vaskuläre Aspekte

Peripheral arterial disease (PAD) is the main factor for lack of wound healing of the lower limb in diabetic patients leading to minor or major amputations. Vascular diagnostics and revascularization allow a significant reduction in major amputation. Furthermore, diabetes is associated with an increased risk for cardiovascular events such as stroke or heart attacks and, therefore, needs an optimal secondary prevention. In addition to macrovascular atherosclerotic disease, functional and structural microvascular changes of the lower limbs are frequent vascular problems found in diabetic foot syndrome (DFS). Screening with the ankle-brachial pressure index is recommended for patients with diabetes mellitus in the absence of wounds. In DFS, additional vascular assessment such a pulse volume recordings and color -coded sonography is indicated. Additional imaging such as digital subtraction angiography is the gold standard for diagnosis of infrapopliteal arterial disease. Depending on atherosclerotic disease patterns in PAD, an open or endovascular revascularization procedure allows improvement of tissue perfusion and wound healing. Following revascularization, a close monitoring of vessel patency with pressure measurements, pulse volume recordings, and sonography is mandatory, and in case of restenosis, reinterventions indicated until wound healing is achieved. Vascular diagnostics and therapy must be combined with wound treatment, anti-infectious therapy, and orthopedic foot decompression in a specialized, interdisciplinary setting.