Correlation between carotid artery disease and peripheral arterial disease in patients with diabetic foot ulcers

Background and aim: Diabetic foot ulcers (DFUs) are often associated with peripheral arterial disease (PAD) and increased cardiovascular risk due to the systemic distribution of atherosclerotic plaques. Carotid artery disease (CAD) shares similar pathophysiological mechanisms with PAD, but its clinical determinants in patients with ischemic DFUs remain poorly defined. This study aimed to assess the prevalence of significant CAD in patients with DFUs and PAD, and to identify clinical and vascular factors influencing its occurrence in this high-risk population. Methods and results: This retrospective study included 75 patients with type 2 diabetes and neuro-ischemic DFUs who underwent lower limb revascularization. Clinical, vascular, and wound characteristics and PAD anatomical severity were recorded. Significant CAD (≥70% stenosis, CAD+) was detected in 8 patients (10.7%), while the remaining 67 patients were classified as CAD–. Compared with CAD– patients, CAD + patients were older (mean age 77 vs 69 years) and more frequently smokers (87.5% vs 13.4%, p < 0.001), whereas no significant differences were observed in metabolic parameters or PAD anatomical severity. Patients with CAD + more frequently exhibited mixed carotid plaques (62.5% vs 30%, p = 0.02), whereas CAD– patients predominantly had calcified plaques (44.8% vs 25%) (p < 0.05). At the multivariate analysis, smoking (OR 7.5; 95% CI 2.1–15.6; p < 0.001) and age >75 years (OR 3.1; 95% CI 1.7–8.1; p = 0.002) emerged as independent predictors of CAD+. Conclusions: In patients with ischemic DFUs and PAD undergoing revascularization, clinically relevant CAD is not uncommon and is primarily driven by age and smoking rather than by other clinical-metabolic characteristics and the severity of PAD.