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Peripheral Revascularization in Diabetic and Nondiabetic Patients: A Single-Center Observational Experience
Slobodan Tanaskovic1, Aleksandra Milacic2, Petar Zekic2
1Vascular Surgery Clinic, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Annals of Vascular Surgery
|May 18, 2026
Summary
Peripheral arterial disease (PAD) patients with diabetes present with more severe, distal disease and foot infections, often requiring endovascular treatment. Those without diabetes face higher amputation rates and mortality, especially with Chronic Limb-Threatening Ischemia.
Area of Science:
- Vascular Surgery
- Diabetology
- Cardiovascular Medicine
Background:
- Peripheral arterial disease (PAD) is a significant cause of morbidity and mortality, especially in patients with diabetes mellitus (DM).
- Diabetic arteriopathy typically affects below-the-knee arteries, leading to ulcerations and infections.
- Understanding clinical differences and outcomes in PAD patients with and without DM is crucial for effective treatment.
Purpose of the Study:
- To compare the clinical characteristics, treatment strategies, and outcomes of PAD patients with and without DM undergoing revascularization.
- To identify distinct patterns of disease presentation and treatment response between diabetic and non-diabetic PAD patients.
- To evaluate amputation rates and survival differences based on diabetes status in PAD patients.
Main Methods:
- Retrospective analysis of 710 PAD patients treated between 2018 and 2024.
- Patients were categorized into PAD with DM (PAD/DM; n=420) and PAD without DM (PAD-only; n=290).
- Follow-up ranged from 1 to 54 months, with analysis of clinical presentation, interventions, and outcomes including amputation and mortality.
Main Results:
- PAD/DM patients presented more frequently with severe ischemia (Fontaine III/IV), foot infections, and gangrene.
- Endovascular treatment was more common in PAD/DM patients, while open surgery predominated in PAD-only patients.
- PAD/DM patients had higher rates of minor amputations and wound revisions; however, PAD-only patients with Chronic Limb-Threatening Ischemia (CLTI) experienced higher major amputation rates and lower overall survival.
Conclusions:
- PAD patients with diabetes exhibit a distinct phenotype of distal disease, foot infections, and increased reliance on endovascular interventions.
- Non-diabetic PAD patients often present with proximal disease requiring open surgery.
- Non-diabetic patients with CLTI face significantly higher major amputation rates and long-term mortality compared to diabetic patients.
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