Peripheral Revascularization in Diabetic and Non-Diabetic Patients: A Single-Centre Observational Experience

Abstract

Introduction 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 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 revascularisation. Methods We retrospectively analysed 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 revascularisation. Follow-up ranged from 1-54 months (mean 17.4). Results 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 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, 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 vs 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). Conclusion In this single-centre 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 open surgery, and when presenting with CLTI, experienced a substantially higher trajectory of major amputations and long-term mortality.