Vascular control

All neuroischaemic feet that present with necrosis must have Doppler studies to confirm ischaemia. This should

Fig. 6.27 (a) There is diffuse atheromatous disease of both superficial femoral arteries with an area of focal narrowing at the mid-level on the right. Both popliteal arteries are severely diseased, (b) On the right there is a single vessel, the anterior tibial, extending to the level of the plantar arch and it is severely diseased in the proximal aspect. There is reconstitution of posterior tibial at ankle level. On the left there is an occlusion of the tibioperoneal trunk with collaterals filling the more distal anterior and posterior tibial arteries. (Courtesy of Dr Huw Walters.)

be followed by non-invasive investigations as described in Chapter 3.

The patient can have either duplex angiography or magnetic resonance angiography to show stenoses or occlusions of the arteries of the leg, particularly in the tibial arteries (Fig. 6.27a,b).

Having diagnosed the site of disease, then revascularization can be planned.

In wet necrosis, revascularization is necessary to heal the tissue deficit after operative debridement. In dry necrosis, which occurs in the background of severe arterial disease, revascularization is necessary to maintain the viability of the limb.

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