[Peripheral artery disease and disorders of microcirculation in patients with diabetes mellitus]

The increase in prevalence of diabetes mellitus and in life expectancy cause the growing number of diabetic patients with peripheral artery disease (PAD). Patients with long standing diabetes suffer frequently (about 70%) from peripheral sensory neuropathy. Therefore these patients miss the symptoms of claudication. Patients with silent ischemia will be classified to stadium I (Fontaine) instead to stadium II or III or their diagnosis will be missed at all. The clinical investigation of the food pulses should be done at least once per year in all patients with diabetes mellitus. When one or more pulses are not detectable the further diagnostic procedures should start with the measurement of the ABI (Ankle Brachial Index). In patients with mediasclerosis the measurement will give false high numbers. After early diagnosis conventional treatment may be effective. With late diagnosis in the stadium IV (Fontaine) always and especially before any amputation revascularisation should be done. Guidelines give the right choice of catheter-based or open vascular-surgical procedures.