'Diabetic tibial disease': the case for revascularisation.

Diabetic patients with critical ischaemia of the lower limb are frequently considered to have unreconstructable vascular disease. In the presence of a palpable popliteal pulse they are often labelled as having 'small vessel disease'. In nine patients (mean age 69 years) with 'diabetic tibial disease' and critical ischaemia we have avoided major amputation using short vein bypasses. All revascularisations remained patent at a mean follow-up of 32 months (range 12-60 months). Diabetic patients with critical ischaemia should at the very least undergo arteriography to ensure that the possibility of successful distal revascularisation is not feasible before amputation is performed. However, if arteriography fails to demonstrate patent distal vessels and limb salvage is considered practical, Doppler insonation of the tibial and pedal vessels should be performed.