Table 4.

The most important findings of our review of the literature.

Frailty is an important clinical problem of modern medicine that is associated with a more severe course of some diseases and with an increased predisposition to the development of additional health problems. The pathogenesis of Frailty is multifactorial.

The 11-factor modified Frailty Index (mFI) is often used to assess Frailty in angiology and vascular surgery.

An ankle-brachial index lower than 0.9 is a criterion for the diagnosis of peripheral arterial disease, and also indicates a greater risk of overall cardiovascular disease. The results of epidemiological studies show that a reduced ABI value is also associated with a greater predisposition to Frailty.

Diabetes mellitus is associated with a greater predisposition to increased vascular stiffness; therefore, the diagnostic value of the ankle-brachial index is lower in this population and the toe-brachial index should also be assessed.

There is a need for further research to confirm the relationship between the toe-brachial index value and the predisposition to Frailty.

The severity of the frailty syndrome may influence the effects of reperfusion treatment of chronic lower limb ischemia, although the results so far are not conclusive in all aspects; therefore, further research is needed.

There is a need to develop uniform, precise criteria for the diagnosis and assessment of the severity of Frailty, adequate both for the needs of research and clinical practice.

The CANVAS study showed that the antidiabetic drug canagliflozin may increase the risk of amputation. However, later studies, including meta-analyses, did not confirm such a relationship.

Assessment of the occurrence and severity of Frailty should be included in the care of patients with diabetes and chronic ischemia of the lower limbs in the selection of adequate management, both in terms of walking training, pharmacological treatment and revascularization treatment. More research is needed in this area.