Published online Jul 10, 2015. doi: 10.4239/wjd.v6.i7.961
Peer-review started: August 30, 2014
First decision: October 28, 2014
Revised: November 20, 2014
Accepted: March 30, 2015
Article in press: April 2, 2015
Published online: July 10, 2015
Peripheral artery disease (PAD) is the atherosclerosis of lower extremity arteries and is also associated with atherothrombosis of other vascular beds, including the cardiovascular and cerebrovascular systems. The presence of diabetes mellitus greatly increases the risk of PAD, as well as accelerates its course, making these patients more susceptible to ischemic events and impaired functional status compared to patients without diabetes. To minimize these cardiovascular risks it is critical to understand the pathophysiology of atherosclerosis in diabetic patients. This, in turn, can offer insights into the therapeutic avenues available for these patients. This article provides an overview of the epidemiology of PAD in diabetic patients, followed by an analysis of the mechanisms by which altered metabolism in diabetes promotes atherosclerosis and plaque instability. Outcomes of PAD in diabetic patients are also discussed, with a focus on diabetic ulcers and critical limb ischemia.
Core tip: Diabetes mellitus (DM) is a major risk factor of peripheral artery disease (PAD), leading to increased morbidity and mortality as well as an accelerated disease course. As such, a more thorough understanding of the multi-factorial mechanisms underlying disease etiology for both DM and PAD is justified. This review provides clinical insight into the current state of research in the pathophysiology of PAD in diabetic patients, as well as highlights the progress of endovascular interventions for PAD, with a focus on techniques that have shown promise for treatment of critical lower limb ischemia.