Purpose: To provide an overview of the pathophysiology, evaluation, diagnosis, and management of vasculogenic erectile dysfunction (ED) using case report of patient with peripheral artery disease (PAD). ED is the most common sexual problem experienced by men with a projected global prevalence affecting 322 million by 2025. Incidence increases with age: 1-10% age <40 years; 2-9% age 40-49 years; 20-40% age 60-69 years, and 50-100% age ≥70 years. Regardless of age, ED causes significant negative effects on self-esteem, intimate relationships, and mental health. ED may be a powerful prognostic indicator for PAD due to common risk factors of increased age, smoking, diabetes, hypertension, and hypercholesterolemia. Methodology: Demographic information and health history of a 66 year old male patient with 40 pack year smoking history including clinical course of PAD, medical and surgical interventions, and suspicion of ED will be presented. Pathophysiologic mechanisms that contribute to the development of ED, diagnostic testing modalities using intracavernous injection and stimulation, pharmacopenile Doppler ultrasonography and measurement of peak systolic velocity will be discussed. Pharmacological management and surgical treatment options of ED will be reviewed. Validated questionnaires to guide assessment, diagnosis, and optimal treatment of ED will be examined. The clinical course and subsequent findings on follow-up visits will be shared. Conclusion: ED can significantly impact emotional well-being, intimate relationships, and quality of life. A concomitant diagnosis with PAD can further intensify the psychological and physiological manifestations of ED. Health care providers should carefully assess males with ED for symptoms of PAD. Questionnaires can aid in exploring this sensitive topic. Further study should be aimed at the overlapping pathophysiologic manifestations in vasculogenic ED and PAD to prevent untoward health care outcomes.

Background Major lower limb amputation is a significant adverse outcome of ulceration and infection from dysvascular causes. Morbidity and mortality is often studied, but post-amputation ambulation is a less studied, albeit important, patient outcome. This study examines patients undergoing major lower limb amputation from dysvascular causes to quantify morbidity, mortality, and post-amputation ambulation outcomes and identify the risk factors associated with these. Methods This was a retrospective cohort study of patients undergoing major lower limb amputation for dysvascular disease between February 2016 – September 2020 within a catchment area of 1/4 of New Zealand. Baseline demographics, comorbidities, 30-day and 1-year mortality, morbidity, and ambulation status at 1 year were obtained from electronic and paper records. Successful ambulation was defined as achievement of iBASIC level mobility on the Locomotor Capabilities Index 5-level (LCI-5) score. A multivariate logistic regression model was used to examine factors associated with the measured outcomes. Results 202 patients underwent 117 below knee amputations and 89 above knee amputations. 30-day morbidity was 68.9%, 30-day mortality was 5.7%, and 1-year mortality was 24.9% . 66 patients (31.6%) achieved successful ambulation after 1-year. Factors associated with successful ambulation were baseline independence with activities of daily living (OR = 3.7, p 0.03), a below-knee amputation (OR = 6.2, p <0.01), and a lower burden of comorbidity (OR = 1.3, p 0.01). These were also associated with decreased mortality. Conclusion Ambulation following major amputation for dysvascular causes was achieved in only 1/3 of patients. Premorbid mobility, function, comorbidities and the level of amputation were associated with successful post-amputation ambulation. Further prospective studies investigating this outcome will enable better counselling and decision-making for patients with dysvascular foot disease.

Background: Although we aim for amputation-free wound healing in diabetic foot ulcers, minor amputation after revascularization is hypothesised to improve wound healing in ischaemic diabetic foot ulcers. Aim of this study is to determine outcomes of ischaemic diabetic foot ulcers (DFU) in relation to the timing of minor amputation after revascularization. Methods: A total of 396 patients who were admitted under Diabetic Foot Ulcer (Vascular) Unit in Monash Health Hospitals (Dandenong Hospital and Monash Medical Centre) from 1 January 2015 to 31 Dec 2019 and had undergone digital subtraction angiography (DSA) with foot ulcers/ gangrene and underlying Diabetes Mellitus were included. Chi-square test was used to determine the association between minor amputation and wound healing. Using Kaplan-Meier survival test, minor amputation versus amputation-free were compared to wound healing, major amputation and overall survival. Results: Minor amputation is significantly associated with wound healing with p<0.001 but insignificantly associated with major amputation with p=0.091. After revascularization, minor amputation accelerates wound healing after six months. It improves 25% of wound healing in ischaemic diabetic foot ulcers. About 40% of these patients would have major amputation and 25% of them did not survive within 2 years. Conclusion: Timely minor amputation hastens rate of wound healing in ischaemic DFU. Unfortunately, most of them would eventually have major amputation within 2 years with 25% mortality rate.

Objective Diabetes related foot ulceration presents an increasing risk of lower limb amputation globally and we are constantly seeking new technologies to manage such a disastrous complication of diabetes. Our single-centre prospective observational study reports on the impact of a bilayer biodegradable synthetic matrix technology (NovoSorb® BTM) on the healing and amputation rates of a complex diabetic foot ulceration cohort. Methods All patients with a diabetes related foot ulceration treated with NovoSorb BTM between December 2019 and October 2021 were prospectively followed up for a minimum of 6 months. Complete wound healing and amputation outcomes were observed. Patients were stratified according to amputation risk, calculated using the Wound, Ischemia and foot Infection (WIfI) classification system. Study outcomes of WIfI stratified patients were compared with global data sets to evaluate impact of BTM. Sub-group analysis of patients with 12-month follow-up data was performed. Results A total of 25 BTM applications to 23 wounds in 22 patients were observed during the nominated time frame (86 % male). Complete wound healing was observed in 61.1 % (n=11) of wounds treated with BTM, 11.1 % (n=2) retained chronic wounds, 16.7 % (n=3) required minor amputation and 11.1 % (n=2) major limb amputation. 12-month amputation risk sub-group analysis included 13 patients stratified to WIfI stage 4 (92 %, n=12) and WIfI stage 3 (8 %, n=1). 12-month major amputation rates observed in this sub-group were 8.3 % (n = 1) for stage 4 and 0% for stage 3. Conclusions Early experience suggests NovoSorb BTM to be a safe and effective treatment for moderate to severe diabetes related foot ulceration, with wound healing and limb salvage outcomes that are comparable or superior to current literature. While larger scale data is required, BTM may represent a promising new addition to the armamentarium of clinicians, who strive to achieve limb salvage in this complex cohort of patients.