Topographic distribution of peripheral arteriopathy in non-diabetics and type 2 diabetics

Peripheral arteriopathy (PA) in type 2 diabetics carries a worse prognosis compared to non-diabetics likely related to a more aggressive course of the macroangiopathy, presence of a prominent microangiopathy and worse results following revascularizations. In addition, the presence of Mönckeberg’s disease in diabetics has an additional negative impact. Interestingly, PA in diabetics compared to non-diabetics is redistributed towards periphery involving predominantly the lower leg arteries. Based on the evidence we suggest that diabetic PA represents a distinct form of a systemic vascular disease characterized by myointimal thickening of macro- and microvascular beds associated with acceleration of the common variety atherosclerosis and in some cases Mönckeberg’s media sclerosis. Despite the systemic involvement specific localizing factors determine the severity and clinical relevance of the diabetic PA in individual vascular beds. In this paper some of the potential localizing factors for diabetic PA are presented and briefly discussed.