To review various noninvasive vascular evaluation methods for prompt and precise assessment of peripheral arterial disease (PAD) for their appropriate application in patients with diabetes mellitus Before commencing interventional therapy, an accurate, noninvasive evaluation of PAD and its location and severity, as well as the physiologic consequences of the disease, is critical to limb preservation initiatives in diabetic patients. Noninvasive vascular studies also provide information on the potential for primary healing of a wound or surgical incision, and help to determine the type of intervention that is most appropriate. Early identification and management of vascular disease is effective in slowing the progress of cardiovascular disease in patients with diabetes. Patients with PAD are at a higher perioperative risk for cardiovascular complications. Therefore, preoperative identification of atherosclerosis may modify perioperative management in these patients, and noninvasive vascular assessment can be used for its early detection. Noninvasive assessment of PAD begins with a physical examination that records pulses, pulsatile masses, bruits, atrophic skin changes, dependent rubor, pallor on elevation and the presence of ulcers or skin breakdown. If PAD is suspected, an ankle-brachial index is performed, or the patient is referred to the noninvasive vascular laboratory (especially if a surgical procedure is foreseen).
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