There is a strong relationship between diabetes and peripheral artery disease (PAD), commonly known as leg vascular occlusion in our community. Early diagnosis of PAD in diabetic patients is particularly important to prevent late-stage complications of the disease, such as non-healing ulcers or gangrene, and to reduce major adverse limb events and major adverse cardiovascular events.
However, diagnosing PAD in diabetic patients is often challenging due to unique characteristics of diabetes itself. Typical PAD symptoms are frequently absent in diabetic patients. Due to physical inactivity and associated neuropathy (nerve damage), diabetic patients may not report claudication (limping) or pain. As a result, PAD diagnosis in diabetic patients typically occurs in advanced stages of the disease, often after the development of diabetic foot complications.
Early detection of PAD in diabetic patients is crucial to prevent worse outcomes. However, symptoms and signs of PAD in diabetes are often masked by the disease’s characteristics, and diagnostic test reliability can be reduced. Therefore, PAD should always be suspected and thoroughly investigated in diabetic patients.

How is Leg Vascular Occlusion Diagnosed in Diabetes?
The diagnosis of PAD involves taking the patient’s clinical history and examining foot pulses during a physical exam. However, physical examination alone is not sufficient to diagnose or rule out PAD. For this reason, diagnostic tests are utilized.
The ankle-brachial index (ABI) is the most commonly used test during physical examinations. The ABI measures the ratio of arterial blood pressure at the ankle to that of the arm. Normal ABI values range between 0.9 and 1.4. Patients with an ABI below 0.9 are diagnosed with arterial narrowing. Although the ABI test does not indicate the exact location of the disease, it is a simple, inexpensive, and rapid test. The lower the ABI, the greater the impact of atherosclerotic disease on the patient. However, ABI measurements are often unreliable in diabetic patients because the disease commonly affects areas below the knee, and widespread arterial calcification can distort the measurements.
Radiological medical imaging methods are used to detect arterial narrowing and occlusion, determine their anatomical location, and assess severity.
Doppler ultrasound is the first imaging method used to detect vascular occlusion. It is relatively easy to perform and low-cost. However, in cases with widespread arterial calcification, visualizing the arteries with this method can sometimes be challenging.
Catheter angiography (DSA) is the gold standard imaging technique for diagnosing leg vascular occlusion. However, it is an invasive method requiring needle and catheter insertion into the blood vessel. Therefore, it is preferred in cases where simultaneous treatment (balloon and stent) will be applied. Typically, before catheter angiography, computed tomography angiography or MR angiography is performed to map the leg’s blood vessels and preliminarily identify areas of narrowing or occlusion.
In diabetic patients, the common localization of the disease below the knee and widespread calcification in the leg vessels reduce the utility of Doppler ultrasound and computed tomography angiography for PAD diagnosis. DSA is often preferred in such cases. It is primarily used for evaluating and treating distal vessels when there is no significant pathology in the larger arteries, as it serves both diagnostic and therapeutic purposes.

What Are the Treatment Options for Leg Vascular Occlusion?
Once diagnosed with leg vascular occlusion, the patient is first advised to make certain lifestyle changes (e.g., quitting smoking, engaging in regular exercise). Depending on the underlying condition (e.g., diabetes, hypertension), specific medications may be prescribed. However, in advanced cases, these measures are typically insufficient. Depending on the condition of the affected artery, the blockage may be treated by angioplasty using a balloon and/or stent, or surgery may be planned in more severe cases.

What is Angiography, and How is it Performed?
Angiography is a medical imaging technique used to visualize blood vessels, particularly arteries, and diagnose arterial pathologies. The groin area is generally used for this procedure, and local anesthesia is applied to prevent pain. An interventional radiologist inserts a thin catheter and guide wires into the artery through the groin. A contrast agent is injected through special catheters placed inside the artery, allowing the anatomy of the artery and any potential diseases to be visualized.

Angiographic Treatment of Leg Vascular Occlusion
Angioplasty for opening leg vascular occlusions is the most important non-surgical treatment for vascular occlusion. Unlike surgery, angiographic treatment does not involve large skin incisions. A thin needle and catheter are used, typically through the groin. It is a reliable method with low risks, and patients are usually discharged on the same day.
Methods commonly used to open occluded vessels during angiography include balloon angioplasty (with or without medication), stents, and atherectomy (plaque shaving). The specific method to be used is determined by the interventional radiologist based on the severity and extent of the disease.