Peripheral arterial disease in diabetes—a review

Abstract

Diabetic patients are at high risk for peripheral arterial disease (PAD) characterized by symptoms of intermittent claudication or critical limb ischaemia. Given the inconsistencies of clinical findings in the diagnosis of PAD in the diabetic patient, measurement of ankle-brachial pressure index (ABI) has emerged as the relatively simple, non-invasive and inexpensive diagnostic tool of choice. An ABI < 0.9 is not only diagnostic of PAD even in the asymptomatic patient, but is also an independent marker of increased morbidity and mortality from cardiovascular diseases. With better understanding of the process of atherosclerosis, avenues for treatment have increased. Modification of lifestyle and effective management of the established risk factors such as smoking, dyslipidaemia, hyperglycaemia and hypertension retard the progression of the disease and reduce cardiovascular events in these patients. Newer risk factors such as insulin resistance, hyperfibrinogenaemia, hyperhomocysteinaemia and low-grade inflammation have been identified, but the advantages of modifying them in patients with PAD are yet to be proven. Therapeutic angiogenesis, on the other hand, represents a promising therapeutic adjunct in the management of PAD in these patients. Outcomes after revascularization procedures, such as percutaneous transluminal angioplasty and surgical bypasses in diabetic patients, are poorer, with increased perioperative morbidity and mortality compared with that in non-diabetic patients. Amputation rates are higher due to the distal nature of the disease. Efforts towards increasing awareness and intensive treatment of the risk factors will help to reduce morbidity and mortality in diabetic patients with PAD.

Selenoprotein P as a diabetes-associated hepatokine that impairs angiogenesis by inducing VEGF resistance in vascular endothelial cells

“…Angiogenic gene therapy using plasmids encoding VEGF has been attempted in patients with coronary or peripheral artery diseases [9]. However, diabetes mellitus people often show a poor response to therapeutic angiogenesis [10].…”

Impact of type 2 diabetes on the plasma levels of vascular endothelial growth factor and its soluble receptors type 1 and type 2 in patients with peripheral arterial disease

“…Macroangiopathic and microangiopathic complications are a major cause of mortality in diabetes. Symptoms like intermittent claudication occur twice as often in individuals with diabetes, which increases the risk of PAD three to four times (Norgren et al, 2007;Jude et al, 2010).…”

A diabeteses láb ischaemiás eredete. Epidemiológia, a diagnózis nehézségei, prevenciós és revascularisatiós lehetőségek

“…A különböző epidemiológiai vizsgálatok-ban a diabetes az érszűkület kockázatát jelentősen emelte (1,9-4,0-szeres rizikó) [4,5]. A HbA 1c értékének 1%-os emelkedése az alsó végtagi verőérszűkület kockázatát 28%-kal emeli [6].…”