ABSTRACT
Peripheral arterial disease (PAD) is a major risk factor for lower extremity amputation, particularly in patients with diabetes. The initial assessment of PAD in patients with diabetes should begin with a thorough medical history and physical examination. Patients with diabetes are more likely to present with ulcers or gangrene than claudication and rest pain due to the extensive nature of their disease and lack of normal foot sensation from sensory neuropathy. Good glycemic control should be a goal of therapy in all patients with PAD and diabetes in order to prevent microvascular complications. Cilostazol is the drug of choice if pharmacologic therapy is necessary for the management of PAD in patients with diabetes. In diabetic patients with complex multilevel disease in the setting of limb-threatening ischemia, a combination of endovascular and surgical therapy may be an effective treatment option associated with lower morbidity than open bypass alone.
