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Assessment and management of peripheral vascular disease in the diabetic patient. Francis Dix Consultant vascular and endovascular surgeon. Peripheral vascular disease with diabetes. diabetes team clinical effects of combined disease pathophysiology assessment treatment – cases.
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Consultant vascular and endovascular surgeon
GP and community services
The World Health Organisation has predicted that deaths from diabetes
in Britain would rise from 33,000 a year in 2005 to 41,000 by 2015 but
Professor Alberti said that figure underestimated its true impact. More
than 80 per cent of sufferers die from heart attacks or strokes and more
than 1,000 a year suffer kidney failure requiring dialysis.
"The WHO figure [for deaths] was very conservative," he said. "Large
numbers die from heart disease and strokes [linked with diabetes] and
they do not include those.“
It costs the NHS £1m an hour to treat. One pound in every £10 spent
on the hospital service is for diabetes and its complications.
type I diabetes and 7.3% in type II
Increased risk of CVD, CAD, nephropathy,
retinopathy and death
- platelet aggregation
- lipid deposition
- plaque formation
and profunda femoris artery disease
- large vessel calcification
- atherosclerotic plaque
- thickening of capillary basement membrane
- increased microvascular flow (hence warm foot)
- oedema secondary to impaired postural vasoconstriction
- increased metabolic requirement
- impaired ability to respond to trauma
- platelet degranulation increased
may be obvious or subtle
- history of rest pain at night
- red (hyperaemic skin)
The long-term results of the Bypass
versus Angioplasty in Severe
Ischaemia of the Leg (BASIL) trial
favour surgery rather than
angioplasty if there is a good vein
and the patient is fit. Some patients
with critical lower limb ischemia are
best treated by analgesia or primary
similar long term outcomes of revascularisation in patients with and without diabetes
Karacagil S et al. Diabet Med 1995; 12: 537-541