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Review: The laboratory evaluation of lower limb perfusion in diabetes mellitus. A clinical review

Wound Healing Research Unit, Department of Surgery and Cardiff Institute of Tissue Engineering and Repair, Cardiff University, UK

Neil D Pugh

Medical Physics and Clinical Engineering Directorate, University Hospital of Wales, Cardiff, UK

Declan P Coleman

Medical Physics and Clinical Engineering Directorate, University Hospital of Wales, Cardiff, UK

Keith G Harding

Wound Healing Research Unit, Department of Surgery and Cardiff Institute of Tissue Engineering and Repair, Cardiff University, UK

Patricia Price

Wound Healing Research Unit, Department of Surgery and Cardiff Institute of Tissue Engineering and Repair, Cardiff University, UK, Pricepe{at}whru.co.uk

on-invasive laboratory tests are commonly employed in the assessment of lower limb perfusion. The accuracy of non-invasive assessments in diabetes remains a concern. We evaluated the more commonly used methods with particular reference to diabetic foot disease. A literature review and clinical evaluation of tests for macrovascular disease, including hand held Doppler, blood pressure measurement and indices, Doppler waveform analysis, colour duplex imaging and plethysmography was performed. Tests reflecting tissue perfusion, including infrared detectors, transcutaneous oxygen tension, laser Doppler, capillaroscopy and skin temperature were also reviewed. Non-invasive laboratory tests reduce the requirement for invasive investigations and their inherent risks. More traditional non-invasive methods are being replaced by evolving techniques employing ultrasound technology. Arterial calcification and peripheral neuropathy associated with diabetes can potentially reduce the reliability of these methods. Distal limb and tissue perfusion assessments are more likely to reflect local vascularity. Tissue perfusion indicators are generally slow and vulnerable to environmental influences, thus limiting their clinical use. Nevertheless, non-invasive tests are an important adjunct to the clinical evaluation of diabetic foot disease. However, diabetes potentially reduces their reliability and the results require careful interpretation. Distal perfusion tests have potential advantages over macrovascular assessments. The influence of diabetes on non-invasive tests needs further evaluation.

Key Words: diabetic foot disease • peripheral arterial occlusive disease • non-invasive tests • tissue perfusion.

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The British Journal of Diabetes & Vascular Disease, Vol. 5, No. 2, 64-70 (2005)
DOI: 10.1177/14746514050050020301


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This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Williams, D. T Articles by Price, P. Search for Related Content Social Bookmarking                         What's this?