The published prevalence rates of PAD vary widely between studies. A recent review by Jude indicates that its prevalence among diabetics is 8–30% [18]; Faglia estimates a prevalence of about 22% in patients with newly diagnosed type 2 diabetes [2], and Prompers a prevalence of about 50% in diabetic patients with foot ulcers [3]. PAD in diabetic subjects is a systemic, obstructive atherosclerotic disease with some particular Pirfenidone in vitro histopathological characteristics, especially the higher incidence of vascular calcifications [19], [20], [21], [22],

[23] and [24]. In comparison with non-diabetics, diabetic patients with PAD are generally younger, have a higher body mass index (BMI), are more often neuropathic and have more cardiovascular co-morbidities

[25]. The clinical peculiarities of obstructive arteriopathy in diabetic patients are its rapid progression and prevalently distal and bilateral topographical expression. Furthermore, the arterial walls are often calcified and occlusions are more frequent than stenoses. The natural adaptive response to reduced flow inside an artery is neo-angiogenesis, CX5461 but this and the capacity to generate compensatory collateral circulations are reported to be reduced in diabetic subjects [26], [27], [28], [29], [30], [31], [32] and [33], even if a recent observation shows better collateral development towards the culprit vessel at least in the coronary artery disease [34]. The anatomical distribution of PAD is different in the diabetic and non-diabetic populations.

In diabetic subjects, PAD more frequently affects below-the-knee vessels such as the tibial and peroneal arteries and is symmetric and multi-segmental, and the collateral vessels can also be affected by stenosis [35] and [36]. The severity of the lesions is also different in the two populations, with diabetic subjects having a larger number of stenoses/obstructions of the deep femoral, popliteal, peroneal, anterior and posterior tibial and even the plantar arteries [37] and [38]. It is Dimethyl sulfoxide essential to define the type and extent of PAD when deciding the clinical prognosis because infra-popliteal involvement is associated with a high risk of major amputation in diabetic subjects who have not undergone distal revascularisation [39]: • PAD is a common complication of diabetes and affects more than 50% of the patients with ulcers. The initial clinical picture is rarely symptomatic (claudication may be absent because of concomitant PN) and more frequently characterised by the ischaemic lesions and gangrene typical of more advanced disease stages.