Microvascular disease increases amputation in patients with peripheral artery disease
Open accessAbstract
It is estimated that >2 million patients are living with an amputation in the United States. Peripheral artery disease (PAD) and diabetes mellitus account for the majority of nontraumatic amputations. The standard measurement to diagnose PAD is the ankle-brachial index, which integrates all occlusive disease in the limb to create a summary value of limb artery occlusive disease. Despite its accuracy, ankle-brachial index fails to well predict limb outcomes. There is an emerging body of literature that implicates microvascular disease (MVD; ie, retinopathy, nephropathy, neuropathy) as a systemic phenomenon where diagnosis of MVD in one capillary bed implicates microvascular dysfunction systemically. MVD independently associates with lower limb outcomes, regardless of diabetic or PAD status. The presence of PAD and concomitant MVD phenotype reveal a synergistic, rather than simply additive, effect. The higher risk of amputation in patients with MVD, PAD, and concomitant MVD and PAD should prompt aggressive foot surveillance and diagnosis of both conditions to maintain ambulation and prevent amputation in older patients.
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The medical management of LEAD in patients with diabetes does not differ from that recommended for patients with ASCVD in general including SGLT2 inhibitors and GLP-1 RAs.
“The medical management of LEAD in patients with diabetes does not differ from that recommended for patients with ASCVD in general including SGLT2 inhibitors and GLP-1 RAs.747,757,764,765”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [757]
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- Authors
- Behroozian, A., & Beckman, J. A.
- Affiliations
- Vanderbilt University Medical Center (US)
- Venue
- Arteriosclerosis, Thrombosis, and Vascular Biology
- Published
- 2020-03
- Volume
- 40
- Issue
- 3
- Pages
- 534-540
- ISSN
- 1079-5642 (ISSN-L)
- 1524-4636
- OpenAlex
- W3008990305
- Cited by
- 94
- References
- 59
- Citations by year
- 2026: 12 · 2025: 18 · 2024: 16 · 2023: 14 · 2022: 18 · 2021: 14 · 2020: 2
- FWCI
- 10.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Arteriosclerosis Thrombosis and Vascular Biology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Heart Association
- Topics
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vascular Procedures and Complications
- Keywords
- peripheral arterial disease, microangiopathy, amputation, ankle-brachial index, diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, limb ischemia
- MeSH terms
- Amputation, Surgical, Health Status, Humans, Microcirculation, Quality of Life, Risk Factors, Treatment Outcome, Lower Extremity, Peripheral Arterial Disease
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