The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes and a foot ulcer

Author:

Fitridge Robert1ORCID,Chuter Vivienne2ORCID,Mills Joseph3ORCID,Hinchliffe Robert4ORCID,Azuma Nobuyoshi5,Behrendt Christian‐Alexander6,Boyko Edward J.7,Conte Michael S.8,Humphries Misty9,Kirksey Lee10,McGinigle Katharine C.11,Nikol Sigrid12,Nordanstig Joakim13,Rowe Vincent14,Russell David15,van den Berg Jos C.16,Venermo Maarit17,Schaper Nicolaas18ORCID

Affiliation:

1. Faculty of Health and Medical Sciences University of Adelaide and Vascular and Endovascular Service Royal Adelaide Hospital Adelaide South Australia Australia

2. School of Health Sciences Western Sydney University Campbelltown New South Wales Australia

3. Baylor College of Medicine Houston Texas USA

4. Bristol Centre for Surgical Research University of Bristol Bristol UK

5. Asahikawa Medical University Hokkaido Japan

6. Department of Vascular and Endovascular Surgery Asklepios Clinic Wandsbek Asklepios Medical School Hamburg Germany

7. University of Washington Seattle Washington USA

8. San Francisco Medical Centre University of California San Francisco California USA

9. UC Davis Medical Centre Sacramento California USA

10. The Cleveland Clinic Cleveland Ohio USA

11. University of North‐Carolina Chapel Hill North Carolina USA

12. Clinical and Interventional Angiology, Asklepios Klinik St Georg Hamburg Germany

13. Sahlgrenska University Hospital Gothenburg Sweden

14. David Geffen School of Medicine UCLA Los Angeles California USA

15. Leeds Teaching Hospitals NHS Trust Leeds UK

16. CENTRO VASCOLARE TICINO Ospedale Regionale di Lugano sede Civico and Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie Inselspital Universitätsspital Bern Switzerland

17. Helsinki University Hospital University of Helsinki Helsinki Finland

18. Division of Endocrinology Department Internal Medicine MUMC+ Maastricht The Netherlands

Abstract

AbstractDiabetes related foot complications have become a major cause of morbidity and are implicated in most major and minor amputations globally. Approximately 50% of people with diabetes and a foot ulcer have peripheral artery disease (PAD) and the presence of PAD significantly increases the risk of adverse limb and cardiovascular events. The International Working Group on the Diabetic Foot (IWGDF) has published evidence based guidelines on the management and prevention of diabetes related foot complications since 1999. This guideline is an update of the 2019 IWGDF guideline on the diagnosis, prognosis and management of peripheral artery disease in people with diabetes mellitus and a foot ulcer. For this guideline the IWGDF, the European Society for Vascular Surgery and the Society for Vascular Surgery decided to collaborate to develop a consistent suite of recommendations relevant to clinicians in all countries. This guideline is based on three new systematic reviews. Using the Grading of Recommendations, Assessment, Development, and Evaluation framework clinically relevant questions were formulated, and the literature was systematically reviewed. After assessing the certainty of the evidence, recommendations were formulated which were weighed against the balance of benefits and harms, patient values, feasibility, acceptability, equity, resources required, and when available, costs. Through this process five recommendations were developed for diagnosing PAD in a person with diabetes, with and without a foot ulcer or gangrene. Five recommendations were developed for prognosis relating to estimating likelihood of healing and amputation outcomes in a person with diabetes and a foot ulcer or gangrene. Fifteen recommendations were developed related to PAD treatment encompassing prioritisation of people for revascularisation, the choice of a procedure and post‐surgical care. In addition, the Writing Committee has highlighted key research questions where current evidence is lacking. The Writing Committee believes that following these recommendations will help healthcare professionals to provide better care and will reduce the burden of diabetes related foot complications.

Publisher

Wiley

Subject

Endocrinology,Endocrinology, Diabetes and Metabolism,Internal Medicine

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