Recommendation 1.1: We suggest that patients with diabetes have ankle-brachial index (ABI) measurements performed when they reach 50 years of age (Grade 2C).

Recommendation 1.2: We suggest that patients with diabetes who have a prior history of DFU, prior abnormal vascular examination, prior intervention for peripheral vascular disease, or known atherosclerotic cardiovascular disease (eg, coronary, cerebral, or renal) have an annular vascular examination of the lower extremities and feet including ABI and toe pressures (Grade 2C).

Recommendation 2: We recommend that patients with DFU have pedal perfusion assessed by ABI, ankle and pedal Doppler arterial waveforms, and either toe systolic pressure or transcutaneous oxygen pressure (TcPO2) annually (Grade 1B).

Recommendation 3: In patients with DFU who have PAD, we recommend revascularization by either surgical bypass or endovascular therapy (Grade 1B).

Recommendation 3 (technical and implementation remarks):

• Prediction of patients most likely to require and to benefit from revascularization can be based on the Society for Vascular Surgery (SVS) Wound, Ischemia, and foot Infection (WIfI) lower extremity threatened limb classification.
• A combination of clinical judgment and careful interpretation of objective assessments of perfusion along with consideration of the wound and infection extent is required to select patients appropriately for revascularization.
• In functional patients with long-segment occlusive disease and a good autologous conduit, bypass is likely to be preferable.
• In the setting of tissue loss and diabetes, prosthetic bypass is inferior to bypass with vein conduit.
• The choice of intervention depends on the degree of ischemia, the extent of arterial disease, the extent of the wound, the presence or absence of infection, and the available expertise.