Approaches to Peripheral Artery Disease in Diabetes: Are There Any Differences?

Figures

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  Figure 1. The pathophysiological hallmarks of PAD in DM. Abbreviations: NO, nitric oxide; LDL, low-density lipoprotein; PAD, peripheral artery disease.

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  Figure 2. Algorithm for the management of PAD. Symbols: † Noninvasive studies include ankle-brachial pressure index, pulse volume recordings, partitioned pressures, and exercise testing. ‡ Cilostazol is recommended for patients with moderate-to-severe claudication. For patients with contraindications or for patients who do not tolerate cilostazol, pentoxifylline is an alternative. These can be prescribed simultaneously with the launching of an exercise program. ¥ CT or MR angiography. For patients with inflow occlusive disease (weak femoral pulse), conventional catheter-based arteriography may be performed initially, in expectation of possible intervention. § Optimal candidates for peripheral bypass surgery have favorable anatomy for bypass (target vessel, good runoff, and, ideally, vein conduit), are medically fit, and have an anticipated life expectancy that will allow the patient to benefit from the procedure. ¶ Following revascularization, antiplatelet therapy depends upon the nature of revascularization (i.e., the type of stent, type of bypass conduit); if initiated, cilostazol may be stopped.