It is estimated that >2 million patients are living with an amputation in the United States. Peripheral artery disease (PAD) and diabetes mellitus account for the majority of nontraumatic amputations. The standard measurement to diagnose PAD is the ankle-brachial index, which integrates all occlusive disease in the limb to create a summary value of limb artery occlusive disease. Despite its accuracy, ankle-brachial index fails to well predict limb outcomes. There is an emerging body of literature that implicates microvascular disease (MVD; ie, retinopathy, nephropathy, neuropathy) as a systemic phenomenon where diagnosis of MVD in one capillary bed implicates microvascular dysfunction systemically. MVD independently associates with lower limb outcomes, regardless of diabetic or PAD status. The presence of PAD and concomitant MVD phenotype reveal a synergistic, rather than simply additive, effect. The higher risk of amputation in patients with MVD, PAD, and concomitant MVD and PAD should prompt aggressive foot surveillance and diagnosis of both conditions to maintain ambulation and prevent amputation in older patients.

中文翻译：

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微血管疾病增加了外周动脉疾病患者的截肢。

据估计，在美国有超过200万患者正截肢。周围动脉疾病（PAD）和糖尿病占非创伤性截肢的大多数。诊断PAD的标准方法是踝肱指数，该指数综合了肢体中的所有闭塞性疾病，从而得出了肢体动脉闭塞性疾病的摘要值。尽管其准确性，但踝臂指数不能很好地预测肢体结局。新兴的文献涉及微血管疾病（MVD；即视网膜病，肾病，神经病），是一种系统性现象，其中在一个毛细血管床中诊断MVD会全身性暗示微血管功能障碍。不论糖尿病或PAD的状态如何，MVD均与下肢预后相关。PAD和伴随的MVD表型的存在显示出协同作用，而不是简单的累加作用。MVD，PAD并发MVD和PAD的患者发生截肢的风险较高，这应促使积极的脚部监测和两种情况的诊断，以维持下床活动并防止老年患者截肢。