Diabetic vascular disease: characteristics of vascular disease unique to the diabetic patient.

Diabetes is a cardiovascular disease affecting almost every arterial vascular bed with significant consequences. Vascular disease is one part of a triopathy of complications that singularly but most commonly in combination makes the diabetic patient uniquely susceptible to lower extremity complications. The other two conditions are neuropathy and an altered response to infection. Diabetic peripheral arterial disease has a predilection for the smaller below knee tibial/peroneal arteries and there is no microvascular occlusive arterial disease affecting the diabetic foot. Microvascular dysfunction is not an occlusive phenomenon and supports an aggressive approach to treating existing macrovascular atherogenic occlusive disease complicating diabetic wounds of all extremities. Individualized, patient-centered treatment utilizing all available endovascular and open revascularization options best ensures the highest quality outcomes at a cost our healthcare system can afford.