Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jul 10, 2015; 6(7): 961-969
Published online Jul 10, 2015. doi: 10.4239/wjd.v6.i7.961
Peripheral artery disease in patients with diabetes: Epidemiology, mechanisms, and outcomes
Thejasvi Thiruvoipati, Caitlin E Kielhorn, Ehrin J Armstrong
Thejasvi Thiruvoipati, Caitlin E Kielhorn, Ehrin J Armstrong, Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Denver, CO 80220, United States
Author contributions: All the authors contributed to this work.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Ehrin J Armstrong, MD, MSc, Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Denver, CO 80220, United States.
Telephone: +1-415-3122480
Received: August 29, 2014
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.

Keywords: Peripheral artery disease, Epidemiology, Pathophysiology, Outcomes, Diabetes

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.