This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

George Andros, MD; Robert W. Harris, MD; Leopoldo B. Dulawa, MD; Robert W. Oblath, MD; Sergio X. Salles-Cunha, PhD

Arch Surg. 1984;119(11):1260-1263.

Abstract
• A group of five diabetic patients had gangrene or failed limited amputations and palpable foot pulses in a total of seven limbs. Because a failure to heal persisted and gangrene progressed, arteriography was performed and disclosed occlusion of all three infrapopliteal arteries. Tibial bypass grafting resulted in complete healing in four of the five patients. The fifth patient refused surgery and died with progressive sepsis. The incidence of this unusual syndrome is unknown, but presumably it is rare. The mechanism of pulse formation in the foot, despite occlusion of the infrapopliteal vessels, is dependent on good flow to the popliteal artery, collateral flow to the rigid distal tibial-peroneal vessels, compliant ankle arteries, and highly resistive distal foot vessels. Although healing of limited amputations is usual in diabetic patients with foot pulses, it is not universal. We recommend that arteriography be performed routinely if gangrene is present and the foot is salvageable, irrespective of pedal pulse status.

(Arch Surg 1984;119:1260-1263)

Author Affiliations
From the Vascular Laboratory, St Joseph Medical Center, Burbank, Calif.

Footnotes
Accepted for publication July 9, 1984.

Read before the Annual Meeting of the Southern California Chapter of the American College of Surgeons, Santa Barbara, Calif, Jan 27, 1984.

Reprint requests to Vascular Laboratory, St Joseph Medical Center, Buena Vista and Alameda, Burbank, CA 91505 (Dr Andros).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Emerging Evidence for Neuroischemic Diabetic Foot Ulcers: Model of Care and How to Adapt Practice
Ndip and Jude
INT J LOW EXTREM WOUNDS 2009;8:82-94.
ABSTRACT  

An Evaluation of the Efficacy of Methods Used in Screening for Lower-Limb Arterial Disease in Diabetes
Toursarkissian
PERSPECT VASC SURG ENDOVASC THER 2006;18:81-83.
ABSTRACT  

Diabetic Foot Wound Care Algorithms
Han and Ezquerro
J. Am. Podiatr. Med. Assoc. 2002;92:336-349.
ABSTRACT | FULL TEXT  

Bypass Surgery Into Plantar Vessels: An Effective Extension of Limb Salvage Surgical Techniques
Sanchez et al.
PERSPECT VASC SURG ENDOVASC THER 1994;7:47-55.
 

Limb Salvage vs Amputation for Critical Ischemia: The Role of Vascular Surgery
Taylor et al.
Arch Surg 1991;126:1251-1258.
ABSTRACT