Characteristics of Peripheral Arterial Disease and Its Relevance to the Diabetic Population

Abstract

Peripheral arterial disease (PAD) is very frequent in diabetics, and it increases with age. Foot examination contributes poorly to diagnosis of PAD. The ankle-brachial index (ABI) measurement is considered the most accurate noninvasive diagnostic method when evaluating PAD: ABI evaluation is recommended in all diabetics aged >50 years. Many diabetic patients with PAD have a concomitant sensitive neuropathy: as a consequence, perception of ischemic pain is remarkably reduced or completely blocked. The result is that the prevalence of claudication in the diabetic population with PAD is lower than the prevalence of critical limb ischemia (CLI) in this population. CLI is a major risk factor for lower extremity amputation without revascularization. Ankle and toe pressures and oxygen tension at the foot are the noninvasive diagnostic parameters of CLI though the medial artery calcification inhibits accurate determination of the ankle and toe pressures, especially when a forefoot ulcer is present. In diabetics, the anatomical localization is mainly distal; arterial wall calcification is frequently observed and occlusion occurs more frequently than stenosis. Such anatomical features, along with the difficulties in the diagnostic approach, account for the fundamental role of CLI as the main prognostic indicator for major amputation. PAD is an expression of systemic atherosclerotic disease. Prognosis of patients with PAD is related to the presence and extent of underlying coronary artery disease (CAD) but also to the severity of PAD: in particular, patients in whom revascularization is not feasible have the highest mortality rate.

Skin Necrosis of Diabetic Foot and Its Management

“…It may have infection but usually is from severe ischemia resulting from vasculopathy. In cases where peripheral artery disease progresses slowly among ischemic-neuropathic diabetic foot patients, it gradually develops vascular compromise of the skin, and thus perception of ischemic pain is reduced [ 11 ]. The result is that the prevalence of claudication in the diabetic population with PAD is lower than the prevalence of critical limb ischemia (CLI) in this population.…”

Reliability of the Vascular Claudication Reporting in Diabetic Patients With Peripheral Arterial Disease

“…Patients with PAD were previously diagnosed at the Vascular Surgery Department, using standard clinical and instrumental examinations. Exclusion criteria from the study were the presence of pathologic conditions: (1) limiting, other than DM, the perception or the reporting of ischemic muscle symptoms (cognitive disorders or stable analgesic treatment); (2) evoking extravascular painful symptoms at the lower limbs masking or confounding the identification of vascular symptoms (spinal stenosis, disk disease, etc); (3) influencing the NIRS trace, such as severe limitations of oxygen transport and extraction (severe anemia or heart failure, myopathy), and/or, (4) conditions that would affect a reliable recording of oxygenation changes by NIRS (eg, edema).…”

“…1 Vascular Diseases Center, University of Ferrara, Italy A total of 193 consecutive patients (143 males; age: 71.1 + 8.6 years) with Fontaine stage 2 PAD with stable claudication were assessed for eligibility during an 18-month period upon entry to a vascular rehabilitation program. Patients with PAD were previously diagnosed at the Vascular Surgery Department, using standard clinical and instrumental examinations.…”

“…1 Few studies have evaluated the reliability of reporting symptoms concerning the lower limbs in diabetic patients with claudication. Altered reporting might affect functional evaluation, patient staging, and might influence the outcome assessment following treatment.…”

Úlceras del pie diabético

“…La diabetes se asocia a un aumento doble o triple en el riesgo de ateroesclerosis acelerada 11 . Su intensidad depende de la duración y la gravedad de la diabetes, la intensidad de la dislipidemia y la presencia o ausencia de obesidad, hipertensión arterial, tabaquismo y antecedentes familiares de ateroesclerosis, así como de la localización de la lesión vascular (proximal o distal).…”