Peripheral Revascularization in Diabetic and Nondiabetic Patients: A Single-Center Observational Experience

Peripheral arterial disease (PAD) is a major cause of morbidity and mortality, particularly among patients with diabetes mellitus (DM). Diabetic arteriopathy primarily affects the below-the-knee (BTK) arteries and is often complicated by ischemic ulcerations and infections. This study describes the clinical characteristics, treatment strategies, and observational outcomes of PAD patients with and without DM undergoing revascularization.

We retrospectively analyzed 710 patients with PAD treated between 2018 and 2024. Patients were grouped into PAD with DM (PAD/DM; n = 420) and PAD without DM (PAD only; n = 290). Symptomatic PAD was defined as intermittent claudication, rest pain, ulceration, or gangrene requiring revascularization. Follow-up ranged from 1 to 54 months (mean 17.4).

PAD/DM patients more often presented with Fontaine III/IV ischemia (P = 0.003), foot infections (37.4% vs. 23.8%; P < 0.001), and gangrene (40.1% vs. 25.9%; P < 0.001). Endovascular treatment was more frequent among PAD/DM patients (71.4% vs. 56.2%; P < 0.001), whereas open surgery (OS) predominated among PAD-only patients (45.0% vs. 26.9%; P < 0.001). Minor amputations and wound revisions were more common in the PAD/DM group (14.0% vs. 2.1%; P < 0.001). No significant differences were observed in intrahospital BTK amputation, above-the-knee (ATK) amputation, surgical site infection, or mortality. During follow-up, ATK amputations were significantly higher in PAD-only patients. When stratifying by disease severity, ATK amputation rates in patients presenting with chronic limb-threatening ischemia (CLTI) were 45.8% in the non-DM group versus 8.7% in the DM group (P < 0.001). Kaplan-Meier analysis demonstrated significantly lower overall survival in the PAD-only group (Log-rank P = 0.011).

In this single-center experience, PAD patients with diabetes presented with a distinct clinical phenotype characterized by distal disease, foot infections, and a reliance on endovascular interventions. Patients without diabetes presented more frequently with proximal disease requiring OS and, when presenting with CLTI, experienced a substantially higher trajectory of major amputations and long-term mortality.