The effect of diabetic micro-/macroangiopathy and neuropathy on the diagnostic and treatment tactic of the lower limb vascular pathologies | Ukrainian Medical Journal

Adamovych Yu.S.,Maksymenko M.V.,Rosokha V.V.,Karpenko L.M.,Havryliuk R.O.

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The effect of diabetic micro-/macroangiopathy and neuropathy on the diagnostic and treatment tactic of the lower limb vascular pathologies

The effect of diabetic micro-/macroangiopathy and neuropathy on the diagnostic and treatment tactic of the lower limb vascular pathologies

October 14, 2025

361

УДК: 616.379-008.64:616.13/.14-089.87(075.8)

DOI: 10.32471/umj.1680-3051.269636

Keywords :

diabetic angiopathies,

diabetic neuropathies,

lower extremity,

peripheral vascular diseases

Specialities :

Surgery

Endocrinology

Resume

Objective: to review the literature on the role of diabetic micro/macroangiopathy and neuropathy in shaping diagnostic strategies and treatment tactics for lower limb arterial and venous pathologies.

Materials and methods. A systematic search of PubMed, Scopus, and Web of Science was performed for publications from 2010 to 2025. Keywords included diabetes mellitus, microangiopathy, macroangiopathy, diabetic neuropathy, peripheral arterial disease, chronic venous insufficiency, varicosis, and deep vein thrombosis. Both original studies and systematic reviews were analyzed, focusing on diagnostic tools, therapeutic options, and patient outcomes.

Results. Diabetic microangiopathy leads to impaired tissue perfusion and atypical ischemia presentation, reducing the reliability of standard diagnostic markers such as the ankle-brachial index. Macroangiopathy accelerates distal arterial atherosclerosis, limiting revascularization options. Venous pathologies are aggravated by diabetic-induced endothelial dysfunction, reduced calf muscle pump activity, and hypercoagulability, increasing the risk of chronic venous insufficiency, varicosis, and DVT. Diabetic neuropathy further complicates the clinical picture by diminishing pain perception and protective sensation, often delaying the recognition of ischemia, infection, or ulceration. It also contributes to abnormal gait mechanics and foot deformities, promoting repetitive trauma and impaired wound healing. Diagnostic strategies require adaptation, incorporating duplex ultrasonography, toe pressure measurement, and advanced imaging modalities. Treatment tactics demand a combined approach: optimized glycemic control, antithrombotic therapy, tailored surgical and endovascular interventions, compression therapy, and multidisciplinary wound care.

Conclusion. Diabetes mellitus markedly complicates the progression of vascular pathologies in the lower extremities, exerting significant impact on both diagnostic accuracy and therapeutic decision-making. Diabetic micro- and macroangiopathy contribute to chronic ischemia, impaired microcirculation, and substantial challenges in achieving effective revascularization. Concurrently, diabetic neuropathy obscures typical clinical signs of ischemia and promotes the formation of trophic ulcers and secondary infections. Standard diagnostic tools — most notably the ankle-brachial index — frequently yield unreliable results due to medial arterial calcification, necessitating the use of complementary non-invasive modalities such as the toe-brachial index, transcutaneous oxygen pressure, duplex ultrasonography, and advanced angiographic imaging. Optimal management requires a multidisciplinary, patient-centered approach incorporating strict glycemic control, pharmacologic prevention of thrombosis and atherosclerosis, appropriate revascularization strategies, compression therapy where indicated, and the use of advanced wound care technologies. Early diagnosis and comprehensive treatment remain critical for reducing the incidence of major amputations and improving clinical outcomes in this high-risk patient population.

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