Date of Award


Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)


Physician Assistant Studies


PAD; peripheral arterial disease; limb ischemia; non-traumatic limb ischemia; diabetic neuropathy; diabetic foot ulcers; revascularization procedures; peripheral vascular disease


Diabetes is rapidly increasing throughout the United States. According to the Center for Disease Control (CDC) (2017), the total number of patients diagnosed with diabetes is 23.1 million, patients with undiagnosed diabetes are 7.2 million, for a combined total number of patients with diabetes exceeding 30.2 million and growing.

According to the CDC (2016), approximately 8.5 million people in the United States have peripheral artery disease (PAD), which includes 12-20% of individuals who are older than age 60. According to a study performed by Swaminathan et al. (2014), 186,000 patients underwent lower extremity amputation (LEA). Data also shows that patients undergoing LEA have a mortality rate of 20% noted within one year, and a 40% to 50% mortality rate indicated within 18 months.

The review of literature analyzed studies that compared vascularization procedures to determine whether early diagnosis and intervention provide benefit to reduce lower extremity amputation in diabetic patients with peripheral arterial disease (PAD) and critical limb ischemia (CLI). The analysis of research also provides scientific data of which providers are performing revascularization procedures, what methods are being used to deliver these treatments, data about their success rates and their cost effectiveness.

After an extensive review of research, it was concluded that early detection and revascularization reduces LEA and increases the quality of life for diabetic patients with PAD and LLI (lower limb ischemia). Research suggests that limb salvage is cost efficient, although unpredictable factors such as patient compliance may skew cost analysis. However, data collected does support that if patients are compliant and clinicians implement a multidisciplinary approach to allow early recognition and intervention, limb salvage is cost efficient.