Vascular imaging and intervention in peripheral arteries in the diabetic patient

Diabetic patients are four times more likely to develop peripheral vascular disease than the general population. This disease is likely to be more agg ressive, with five times more patients developing critical limb ischaemia. Early diagnosis and treatment allows up to 80% of these patients to have so me form of surgical or endovascular re-vascularisation. The primary imaging modalities to be used should be duplex ultrasound followed by angiography. Magnetic resonance angiography, however, holds out promise for the future as being a good method of non-invasive imaging. Endovascular (interventiona l radiological) procedures have a major role to play in treatment of vascul ar stenoses and occlusions. Thrombolytic agents can be used to dissolve thr ombus within occluded vessels and so restore patency. Percutaneous translum inal angioplasty is of value in dilating the stenotic lesions within the ve ssels and so restoring normal blood flow. Endovascular stents may be insert ed to ensure longer term patency. There is indirect evidence to suggest that the outcomes of endovascular pro cedures in the diabetic patient are less good than those in the general pop ulation, but nevertheless such procedures may save the diabetic patient fro m primary amputation and allow healing of ischaemic ulcers. Copyright (C) 2 000 John Wiley & Sons, Ltd.