Recommendation ID
CG119/3
Question
Does early revascularisation improve outcome in patients with diabetes and a foot ulcer?
Any explanatory notes
(if applicable)
Peripheral arterial disease (PAD) is very common in patients with diabetes and reduces the blood supply to the limb. It is easy to identify PAD by non-invasive imaging but this does not indicate whether revascularisation is indicated as the patients may have compensated for the PAD with collaterals (side channels) and have adequate circulation to heal the wound. Revascularisation procedures such as angioplasty and bypass surgery are invasive, carry risk and are costly. However, delay in revascularisation is associated with worse outcomes and increases risk of limb loss. There is no evidence for the best type of re-vascularisation procedure or of the optimum time to carry this out in patients with diabetes. There is no evidence or consensus which patients with diabetes and foot wounds need the circulation to their leg improving (revascularisation) to allow healing of their foot wound. Reduced blood supply impairs wound healing. Patients with diabetes and foot complications in the presence of reduced circulation have the worst prognosis of all such patients and are the most likely to suffer amputation. A randomised clinical trial enrolling only patients with diabetic foot problems receiving an early revascularisation is required to assess the costs associated with this intervention.

Source guidance details

Comes from guidance
Diabetic foot problems: Inpatient management of diabetic foot problems
Number
CG119
Date issued
March 2011

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No