Peripheral artery disease in patients who have diabetes tends to have a much more uniform and widespread and a much more aggressive form than those patients who don’t have diabetes. And patients who have diabetes and peripheral artery disease tend to have a higher mortality rate and higher rate of major amputations. One of the greatest tools that we have right now for diagnosing peripheral artery disease is the ankle brachial index, but we don’t routinely use that alone in measurements. We look at the big picture, because in patients who have significant atherosclerosis and who are diabetic, even if you have a high ankle brachial index which would mean it’s normal, it could actually be a harbinger of something worse.
Treatment for patients who have peripheral artery disease really depends on the severity of their condition, and we typically like to start with lifestyle modification changes. We want to make sure that they’re on a good exercise program. We want to make sure that they see a nutritionist and that they not smoke. We want to make sure that they have tight blood pressure control; that they have their cholesterol levels in check; and that they have their glucose levels in check. And then from there, more refractory or more difficult cases to control, we think of things like surgery or spinal cord stimulation.