ASIMPTOMATIC PERIPHERAL ARTERY DISEASE AT PATIENT WITH DIABETES MELLITUS TYPE 2-CASE REPORT

Abstract

Periferal artery disease is most often caused by atherosclerosis,a plaque formation in arteries that suplly blood to the extremities such as legs and arms. When these fatty deposits collect in arteries it narrows the opening and blocks effective blood flow.Type 2 diabetes mellitus constitutes a prevalent and significant public health concern in the context of an aging society,particularly when disease management is suboptimal.Amnog individuals with T2DM the risk of developing PAD is 1.5 to 4 times higher compared to non-diabetic individuals.The American College of Cardiology defines the presentation of PAD by four categories:asymptomatic,claudication,critical limb ischemia and acute limb ischemia.PAD often present as a silent condition with fewer than 20% of patients developing typical symptoms.Diabetic peripheral neuropathy can mask the characteristic pain and discomfort associated with PAD,resulting in a higher prevalence in asymptomatic cases.It is estimated that one-third of all diabetic patients may have asymptomatic PAD.DPN and PAD are responsible for a dramatic increase in the risk of foot ulceration and non traumatic lower limb amputations, bad quality of life and economic burden on society.Diabetic patients with stable blood glucose control and good managing of other risk factors are important in preventing these complications.We present a case of 74 old female patient who came to Internal department in Clinical Hospital Shtip with ongoing tobacco smoking more than 40 years,hypertension(160/90),coronary heart disease(St.post Primary PCI/Stenting to LAD,2019),DM typ 2 with elevated HBA1C(8,2%),FPG=16,8,GFR(51 ml/min) and dyslipidemia.The endocrinologist modified her insulinotherapy and added SGLT inhibitor,cardiologist modified her antihypertensive therapy and requested further tests of which only Doppler ultrasound was notable for aterosclerossis of lower extremeties and than CT angiography revealed extensive substenosis of both femoral arteries and patient was reffered to vascular surgeon,by pass surgery was done.Unterated PAD and uncontrolled dibetes can lead to heart attack,stroke and limb amputations.It is important to understand the connection between diabtes and PAD,to recognize the high risk profiles and to lower risk for both conditions.