Periferna arterijska bolezen in diabetes = Peripheral artery disease and diabetes mellitus
Zaletel, Jelka ; Urbančič-Rovan, Vilma
In diabetic patients, peripheral artery disease develops earlier and its progression is faster than in the non-diabetic population. Among the large vessels, below-knee arteries (tibial, peroneal and ...their smaller branches) areaffected most frequently. Smaller vessels can be affected as well, leading to intermittent claudication in atypical sites in the leg. In addition to atherosclerosis of the arteries, diabetic neuropathy is very frequently present. The signs and symptoms often reflect both pathologies and the clinical picture of ischemia may not be typical. Among the diagnostic tests, Doppler perfusion pressure measurement might show falsely elevated values due to mediocalcinosis. Treatment is targeted to smoking cessation, antiplatelet therapy and exercise. In diabetic patients, glycemia should be normal and targets for blood pressure and lipids are set lower: blood pressure 130/80 mmHg or lower, total cholesterol 4.5 mmol/l or lower and LDL cholesterol 2.5 mmol/l or lower. The success rate of revascularization procedures in diabetic patients is comparable to that in non-diabetics. Peripheral vascular disease is a marker of very high risk of cardiovascular morbidity and mortality. Thus,these patients should be monitored carefully and the treatment should be multifactorial and intensive.
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