Which arteries are commonly affected by diabetes?

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Last updated: November 11, 2025 • View editorial policy

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Arteries Commonly Affected by Diabetes

Diabetes primarily affects the lower extremity arteries (particularly below-knee vessels including the popliteal, tibial, and peroneal arteries) and the carotid arteries, with diabetes increasing the risk of lower extremity arterial disease (LEAD) by 2-4 fold and significantly elevating carotid artery stenosis risk. 1

Lower Extremity Arterial Distribution

Specific Arterial Involvement

  • Below-knee vessels are characteristically affected in diabetes, with typical lesions occurring in the popliteal artery and vessels of the lower leg (tibial and peroneal arteries). 1
  • The distribution is notably distal and diffuse, distinguishing diabetic arterial disease from non-diabetic peripheral artery disease. 2
  • Specific arteries requiring examination include the femoral, popliteal, dorsalis pedis, and posterior tibial arteries. 1
  • Diminished or absent dorsalis pedis pulsation occurs in 16% of diabetic adults aged 35-54 years and 24% of those aged 55-74 years. 1

Clinical Significance

  • This distal pattern of involvement reduces revascularization options and decreases success rates compared to more proximal disease. 1
  • The below-knee predilection makes diabetic patients particularly susceptible to critical limb-threatening ischemia (CLTI), with 50-70% of all CLTI patients having diabetes. 1
  • Diabetic patients with PAD are 7-15 times more likely to require amputation than non-diabetics with PAD. 3

Carotid Artery Disease

  • Carotid artery stenosis is strongly associated with diabetes and other classical risk factors, irrespective of age. 1
  • The presence of carotid artery disease increases stroke risk 2.5-3.5 times higher in diabetic patients. 1
  • Approximately 20% of all ischemic strokes are causally related to carotid artery stenosis. 1

Multi-Site Atherosclerosis Pattern

  • Diabetes is present in a significant proportion of patients with multi-site atherosclerosis, who have worse prognosis than those with single disease location. 1
  • The coexistence of both carotid and lower extremity atherosclerosis in diabetic patients confers the highest cardiovascular and cerebrovascular risk (OR 2.869 for cardiovascular events). 4
  • Coronary arteries are also commonly affected, with PAD and coronary artery disease frequently coexisting due to shared atherosclerotic pathophysiology. 3, 5

Screening Implications

Annual Screening Requirements

  • All diabetic patients require annual clinical screening for peripheral artery disease at different vascular sites. 1
  • Physical examination must include measurement of blood pressure in both arms, auscultation and palpation of carotid arteries, palpation of femoral arteries, and palpation of femoral, popliteal, dorsalis pedis, and posterior tibial arteries. 1
  • Ankle-brachial index (ABI) measurement is recommended annually for LEAD detection, with ABI <0.9 diagnostic for LEAD. 1

Diagnostic Caveats

  • ABI accuracy is lower in diabetic patients due to medial arterial calcification, which may falsely elevate readings (ABI >1.40). 1, 3
  • When ABI >1.40 is present, alternative tests including toe-brachial index (TBI), Doppler waveform analysis, or post-exercise ABI should be utilized. 1
  • LEAD is associated with ABI <0.90 in 50% of cases even when ABI >1.40 due to medial calcinosis. 1

Risk Stratification

  • Duration and severity of diabetes particularly influence the risk of gangrene and ulceration. 1
  • The risk of developing PAD is proportional to diabetes severity and duration. 3
  • Diabetic patients often present with atypical pain patterns and may have CLTI as the first clinical manifestation due to concomitant neuropathy masking symptoms. 1

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Guideline

Relationship Between PVD and PAD in Patients with Risk Factors

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

5
Research

Pathogenesis of atherosclerosis in diabetes and hypertension.

Clinical and experimental hypertension (New York, N.Y. : 1993), 1999

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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