title: Association of foot ulcer with tibial artery calcification is independent of peripheral occlusive disease in type 2 diabetes.
abstract: OBJECTIVE
  To determine the relationship between foot ulcers, arterial calcification, and peripheral occlusive disease in patients with type 2 diabetes.
  
  
  METHODS
  We performed a cross-sectional study on 162 patients with type 2 diabetes who underwent assessment of tibial artery calcification (TAC) by non-contrasted CT scan. Peripheral artery occlusive disease was assessed by angiography. Foot status including the presence or absence of ulcers was documented at presentation. A multivariable logistic regression model was used to evaluate the association between foot ulcers, arterial calcification, and the extent of peripheral atherosclerotic occlusive disease.
  
  
  RESULTS
  Patients with foot ulcers (N=31) were more likely to be older and have a history of tobacco use. They were also more likely to have higher TAC scores (median [IQR]: 4324.6 [609.9, 11163.6] vs. 9.4 [0.0, 343.9], P<0.001) and more advanced peripheral artery occlusive disease (occlusion index 5.5 [4.8, 6.4] vs. 2.2 [1.0, 3.6], P<0.001). Foot ulcer was strongly associated with elevated TAC scores in a multivariable regression model (odds ratio [95% CI]=2.76 [1.61, 4.75], P=0.0002).
  
  
  CONCLUSIONS
  There is a strong association between arterial calcification and diabetic foot ulcers that persists after adjusting for the extent of atherosclerosis in patients with type 2 diabetes.
authors.affiliation: Division of Vascular Surgery, Vanderbilt Medical Center, Nashville, TN 37232, United States. raul.guzman@vanderbilt.edu
authors.forename: Raul J
authors.initials: RJ
authors.lastname: Guzman
authors.forename: Aihua
authors.initials: A
authors.lastname: Bian
authors.forename: Ayumi
authors.initials: A
authors.lastname: Shintani
authors.forename: C Michael
authors.initials: CM
authors.lastname: Stein
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000150:complications*; D002114:Calcinosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D017719:Diabetic Foot / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications*; D011446:Prospective Studies; D011859:Radiography; D016909:Tibial Arteries / Q000503:physiopathology*