I apologize for the delayed response. I have a couple of questions and remarks about your husband's problem. First, there are different type of indexes. There is an ankle brachial index and a toe brachial index. In general, for diabetics, the ABI may be less reliable because of the presence of calcification making the vessel noncompressible. The TBI is more reliable and should be greater than .6. Secondly, it is quite uncommon to have poor circulation to the extent that it causes a toe ulceration, from a superficial femoral artery blockage in the absence of other blockages below the knee. Conversely, it is not uncommon that a diabetic because of the way shoes fit or for other reasons, develops an ulcer and then the mild to moderate impairment caused by that type femoral artery blockage-prevents the ulcer from healing.
Secondly, it is not uncommon to develop neuropathy in the toes, even in the presence of tight blood glucose control.
In any case, when ulcers are present and there are no signs of uncontrolled infection, operation is commonly performed as soon as reasonably possible. this is usually after heart tests demonstrate that the patient can tolerate an operation. The other consideration, is to know if there is any minimally invasive procedure that can be done to re establish blow flow (like angioplasty, stenting or atherectomy) instead of surgery
I'm a little confused as to why he's seen three surgeons and you seem to be at odds with the most recent VS who appears to have the final decision.. I would request a meeting with your surgeon to discuss your concerns. As you know, it is very complex and every bit of detailed information (much of which I dont have) is important. Perhaps a discussion will allow your doctor to better explain his decision not to proceed immediately
Good luck and Best of health