WRITE A BRIEF AND ACCURATE INTRODUCTION ON PREVALENCE OF PVD IN DIABETIC FOOT USING VARIOUS PUBLISHED RESERCH ARTICLES FPR THESIS

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Diabetes mellitus (DM) is one of the most important global public health problems and is associated with numerous microvascular and macrovascular complications. Among these, diabetic foot ulcer (DFU) remains one of the leading causes of hospitalization, disability, and lower limb amputation. The lifetime risk of developing a diabetic foot ulcer is estimated to be as high as 25%, making it a significant contributor to morbidity, mortality, and healthcare expenditure in diabetic patients.¹ Diabetic foot is defined as infection, ulceration, or destruction of deep tissues of the foot associated with neuropathy and varying degrees of peripheral vascular disease (PVD) in patients with diabetes mellitus. The development of diabetic foot is multifactorial, involving peripheral neuropathy, peripheral arterial disease, infection, foot deformity, repetitive trauma, and impaired wound healing. Among these factors, peripheral vascular disease is one of the most important determinants of ulcer healing, limb salvage, and overall prognosis.³ Peripheral vascular disease, also referred to as peripheral arterial disease (PAD), is characterized by progressive narrowing or occlusion of the arteries supplying the lower extremities due to atherosclerosis. Diabetes accelerates atherosclerosis through endothelial dysfunction, chronic inflammation, platelet activation, oxidative stress, and vascular calcification. These changes predominantly affect the distal infrapopliteal vessels, resulting in reduced tissue perfusion, impaired oxygen delivery, delayed wound healing, and increased susceptibility to infection.¹ The coexistence of peripheral neuropathy and peripheral vascular disease presents a unique challenge in diabetic foot management. Neuropathy masks the classical symptoms of ischemia such as intermittent claudication and rest pain, leading to delayed diagnosis of vascular insufficiency. Consequently, many patients present with advanced ischemia, extensive tissue loss, gangrene, or infection by the time medical attention is sought. Early identification of peripheral vascular disease is therefore essential to prevent progression to critical limb ischemia and major amputation.³ Several studies have demonstrated that peripheral vascular disease is highly prevalent among patients with diabetic foot ulcers, although the reported prevalence varies depending on study population, diagnostic methods, and geographical location. In a prospective study involving 392 patients with diabetic foot ulcers, Azhar et al. reported a prevalence of peripheral arterial disease of 43.87%. Patients with peripheral arterial disease had significantly lower limb salvage rates (48.3%) compared to those without vascular disease (82.3%), and PAD was identified as an independent predictor of major lower limb amputation.² Similarly, Sravanthi et al. conducted a hospital-based observational study involving 95 diabetic foot patients and reported a prevalence of peripheral vascular disease of 47.3%. The study demonstrated a significant association between increasing severity of peripheral vascular disease, higher Wagner grading, and major amputation. Advanced age and poorly controlled diabetes mellitus were also identified as important risk factors for peripheral vascular disease.⁵ In another Indian study, Rathnaganpathi and Raghupathy evaluated 100 patients with diabetic foot ulcers using clinical examination, Doppler ultrasonography, and ankle-brachial pressure index (ABPI). The prevalence of peripheral arterial disease was 29%. Important associated risk factors included smoking, hypertension, dyslipidemia, coronary artery disease, prolonged duration of diabetes, and barefoot walking.³ Das et al. evaluated peripheral vascular disease among diabetic patients with and without foot involvement using ankle-brachial pressure index and duplex ultrasonography. The authors reported a remarkably high prevalence of 72.2% among diabetic patients with foot disease and demonstrated a strong association between increased intima-media thickness and peripheral vascular disease, emphasizing the importance of vascular screening in diabetic patients.¹ Nobi et al. conducted a prospective observational study on diabetic foot infections and found peripheral vascular disease in 34.7% of patients. Older age, tobacco use, prolonged hospital stay, delayed wound healing, and increased pain scores were significantly associated with vascular insufficiency. The authors recommended routine vascular assessment using duplex ultrasonography, ankle-brachial pressure index, and pulse oximetry in all diabetic foot patients regardless of clinical symptoms.⁴ More recently, Kumar et al. performed a retrospective study at AIIMS Patna involving 120 patients with diabetic foot ulcers. Peripheral vascular disease was diagnosed in 26.7% of patients by Doppler ultrasonography, while 24% demonstrated arterial insufficiency based on ABPI measurements. The study concluded that routine vascular assessment facilitates early diagnosis and timely intervention, thereby improving clinical outcomes and reducing the risk of major amputations.⁶ Diagnosis of peripheral vascular disease in diabetic foot patients relies on a combination of careful clinical examination and objective vascular assessment. Clinical evaluation includes palpation of peripheral pulses, assessment of skin temperature, capillary refill, ulcer characteristics, and symptoms of ischemia. However, because neuropathy often masks ischemic symptoms, objective investigations such as ankle-brachial pressure index, handheld Doppler examination, duplex ultrasonography, computed tomography angiography, and digital subtraction angiography are essential for accurate diagnosis and severity assessment.¹–⁶ Early identification of peripheral vascular disease has significant therapeutic implications. Timely recognition allows optimization of glycemic control, smoking cessation, management of cardiovascular risk factors, initiation of antiplatelet and statin therapy, appropriate wound care, infection control, and consideration of endovascular or surgical revascularization when indicated. These interventions improve ulcer healing, enhance limb salvage, reduce amputation rates, and improve quality of life.²–⁶ Despite the growing burden of diabetes in India, data regarding the prevalence of peripheral vascular disease among patients with diabetic foot ulcers remain limited and show considerable regional variation. Determining the prevalence of peripheral vascular disease and identifying associated risk factors are essential for improving screening strategies, facilitating early intervention, and reducing diabetes-related lower limb amputations. Therefore, the present study was undertaken to determine the prevalence of peripheral vascular disease among patients presenting with diabetic foot ulcers and to evaluate its clinical significance.

INTRODUCTION USING BOTH