DIABETIC VASCULAR DISEASE

People with diabetes are at substantially higher risk of developing vascular disease than the general population. Both type 1 and type 2 diabetes accelerate atherosclerosis - the build-up of fatty deposits within artery walls - leading to earlier and more extensive narrowing of the blood vessels supplying the legs and feet.

Professor Zayed has a particular specialist interest in vascular disease in people with diabetes, and has led extensive research and published widely in this field. He understands that diabetic arterial disease presents unique challenges: it tends to affect the smaller arteries below the knee (tibial and peroneal vessels), is often more diffuse and calcified than non-diabetic disease, and requires technical expertise in both endovascular and surgical revascularisation to achieve the best outcomes.

Chronically elevated blood glucose damages blood vessel walls in several ways, accelerating the formation of atherosclerotic plaques and reducing the elasticity of the arterial wall. In addition, diabetes is frequently accompanied by other cardiovascular risk factors - including hypertension, dyslipidaemia, and obesity - which compound the risk further.

Two distinct but often coexisting conditions contribute to vascular complications in diabetes:

Peripheral arterial disease (macrovascular disease)
Narrowing of the larger arteries supplying the legs and feet, causing reduced blood flow. In people with diabetes, this tends to affect the tibial and peroneal arteries (below the knee) more than in non-diabetic individuals, making revascularisation technically more challenging but no less important.

Peripheral neuropathy
Nerve damage caused by prolonged hyperglycaemia reduces pain sensation in the feet, meaning that injuries, pressure sores, and early infections may go unnoticed until they have become established. This combination of reduced blood supply and impaired sensation creates the conditions for diabetic foot ulceration

Diabetic foot complications - including ulceration, infection, and gangrene - are the leading cause of non-traumatic lower limb amputation in the UK. Around 135 amputations are performed every week in England as a result of diabetes. The majority of these are considered preventable with timely and appropriate vascular intervention.

Warning signs - seek prompt assessment

•    A new wound, blister, or break in the skin of the foot or toes
•    Redness, warmth, or swelling around a wound
•    Darkening or discolouration of the toes
•    A wound that has not healed within two weeks
•    Loss of sensation in the feet
•    Cold or pale feet, with absent foot pulses

If you have diabetes and develop any of the above, you should seek urgent medical assessment. Early intervention dramatically improves the chances of wound healing and limb preservation.

Professor Zayed's approach to diabetic vascular disease is focused on limb salvage - restoring adequate blood flow to allow wound healing and avoid amputation wherever possible. This requires a combination of technical expertise in below-knee revascularisation and close collaboration with the wider multi-disciplinary team including diabetologists, podiatrists, and specialist wound care nurses.

Endovascular revascularisation
Minimally invasive techniques - including balloon angioplasty and drug-coated balloon technology - can be used to open narrowed tibial and peroneal arteries supplying the foot, restoring blood flow without the need for open surgery. Professor Zayed has expertise in complex infrapopliteal (below-the-knee) endovascular procedures, including the extreme advanced techniques such as percutaneous deep venous arterialisation.
 

Surgical bypass - femorodistal and pedal bypass
Where the anatomy or extent of disease makes endovascular treatment unsuitable, surgical bypass using the patient's own vein can restore blood flow to the foot. Professor Zayed performs femorodistal and pedal bypass procedures - technically demanding operations that route blood around blocked arteries to vessels at or below the ankle - with the aim of healing the wound and saving the limb.

Risk factor optimisation
Alongside revascularisation, optimising blood glucose control, blood pressure, and lipid management is essential to slow the progression of arterial disease and reduce the risk of further complications. Professor Zayed works closely with diabetes specialist colleagues to ensure a comprehensive approach to each patient's care.