Approximately 1 in 16 Americans has diabetes mellitus. It has been estimated that one-third of these people are unaware that they have the disease. Diabetes results in a 15- to 40-fold increased risk of amputations compared to the nondiabetic population. Each year an estimated 67,000 limbs are lost due to complications of diabetes. Long-standing diabetes causes damage to nerves and lowers resistance to infection. The loss of sensation associated with diabetic neuropathy causes deformities of the boney structure of the foot and abnormal pressure points that lead to erosions of the skin and subcutaneous tissue. Once the line of defense provided by the skin is disrupted, infection and gangrene can develop.

The most effective form of prevention is identification of patients at risk. Diabetic patients who have lost protective sensation may need special footwear to prevent ulcers from occurring. When ulcers develop, it is important to document the status of the circulation to the feet by careful pulse examination, or noninvasive vascular studies.

A vascular surgeon should evaluate nonhealing ulcers or gangrene in a diabetic patient. Occasionally the circulation can be improved by minimally invasive, endovascular techniques. Frequently the extent of atherosclerosis seen in diabetic patients demands a surgical approach. Vascular Surgery Associates has extensive experience with complicated operations to improve circulation in diabetic patients. The chance of saving a threatened leg with impaired circulation is at least 90%.