{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T13:20:24Z","timestamp":1770988824204,"version":"3.50.1"},"reference-count":43,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Objective: This study aimed to compare thromboangiitis obliterans (TAO) and diabetic peripheral vascular disease (DPVD), the two major causes of distal limb ischemia, within a single analytical framework. The comparison was not limited to practical biomarkers that could support differential diagnosis but was based on multidimensional parameters that determine the clinical spectrum and prognosis. The two cohorts were systematically evaluated in terms of demographics and comorbidity burden, clinical presentation and limb involvement pattern, ulcer prevalence and localization, real-life treatment strategies (medical, endovascular, and surgical), and hard clinical endpoints (major\/minor amputation, hospitalization, and all-cause mortality). DPVD was phenotyped according to the lesion level as isolated distal, isolated proximal, or multilevel. Within this framework, the isolated distal diabetic peripheral vascular disease (d-DPVD) subgroup was analyzed to determine how it differs from TAO in terms of clinical course, treatment patterns, and outcomes, despite the distal anatomical similarity. Methods: In this single-center retrospective cohort study, conducted between June 2019 and June 2025, 120 non-diabetic patients who met the angiographic TAO criteria were compared with 395 patients with DPVD with infrapopliteal\/pedal atherosclerotic involvement. Clinical characteristics, ulcer topography, treatment strategies, and outcomes were recorded. The discriminatory value of the blood count and lipid-based inflammatory\/atherogenic indices were evaluated using logistic regression and receiver operating characteristic (ROC) curve analyses. Additionally, a separate subgroup analysis was performed for the d-DPVD subgroup, which was considered the closest to the TAO phenotype in this study design. Results: Patients with DPVD were significantly older than those with TAO (61.1 \u00b1 12.1 vs. 39.7 \u00b1 7.9 years; p &lt; 0.001), and male predominance was more pronounced in the TAO group (94.2% vs. 84.8%). Compared with TAO, DPVD was associated with a higher cardiometabolic comorbidity burden and increased inflammatory and atherogenic indices. Although the overall ulcer prevalence was comparable, DPVD more frequently presented with plantar or proximal ulcers confined to a single extremity, whereas TAO was characterized by bilateral or multi-extremity involvement and distal acral ulceration. Antiplatelet and statin therapy, revascularization, and rates of major amputation, all-cause mortality, and hospitalization were higher in patients with DPVD (all p &lt; 0.05). On multivariate analysis, age, cumulative smoking exposure, SIRI, and CRI-I independently distinguished DPVD from TAO (all p &lt; 0.05). In the isolated distal DPVD subgroup, despite similar distal anatomy, inflammatory\/atherogenic burden, and overall clinical risk remained adverse. Conclusions: TAO and DPVD are two distinct phenotypes with different pathobiologies and prognoses, despite similar distal ischemia presentations. Simple inflammatory and atherogenic composite indices, evaluated in conjunction with clinical\/ulcer patterns, may support the differential diagnosis and risk stratification of patients with peripheral arterial disease (PAD). However, prospective multicenter validation of these findings is required to confirm the results.<\/jats:p>","DOI":"10.3390\/diagnostics16040560","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T12:06:59Z","timestamp":1770984419000},"page":"560","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diabetic Peripheral Arterial Disease Versus Thromboangiitis Obliterans: A Multidimensional Comparison of Clinical Phenotype, Biomarkers, and Outcomes"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9182-0690","authenticated-orcid":false,"given":"Murat","family":"Y\u00fccel","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Ankara Bilkent City Hospital, Ankara 06800, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7510-298X","authenticated-orcid":false,"given":"Hakan","family":"\u00c7omakl\u0131","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Ankara Bilkent City Hospital, Ankara 06800, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0744-0001","authenticated-orcid":false,"given":"Muhammet Fethi","family":"Sa\u011flam","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Ankara Y\u0131ld\u0131r\u0131m Beyaz\u0131t University Faculty of Medicine, Ankara 06010, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kemal E\u015fref","family":"Erdo\u011fan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Ankara Y\u0131ld\u0131r\u0131m Beyaz\u0131t University Faculty of Medicine, Ankara 06010, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nur Gizem","family":"Elipek","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Ankara Bilkent City Hospital, Ankara 06800, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00d6mer Abdullah","family":"Yavuz","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Ankara Bilkent City Hospital, Ankara 06800, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2758-7644","authenticated-orcid":false,"given":"Emrah","family":"U\u011fuz","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Ankara Y\u0131ld\u0131r\u0131m Beyaz\u0131t University Faculty of Medicine, Ankara 06010, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1097\/01.bor.0000198000.58073.aa","article-title":"Thromboangiitis obliterans (Buerger\u2019s disease)","volume":"18","author":"Olin","year":"2006","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"827","DOI":"10.4239\/wjd.v12.i6.827","article-title":"Diabetes and peripheral artery disease: A review","volume":"12","author":"Soyoye","year":"2021","journal-title":"World J. Diabetes"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1038\/s41392-023-01400-z","article-title":"Diabetic vascular diseases: Molecular mechanisms and therapeutic strategies","volume":"8","author":"Li","year":"2023","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1177\/1358863X9700200109","article-title":"Thromboangiitis Obliterans (Buerger\u2019s Disease)","volume":"2","author":"Aqel","year":"1997","journal-title":"Vasc. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1007\/s13300-024-01606-6","article-title":"Epidemiology and Burden of Peripheral Artery Disease in People with Type 2 Diabetes: A Systematic Literature Review","volume":"15","author":"Verma","year":"2024","journal-title":"Diabetes Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.18203\/2349-2902.isj20241283","article-title":"Thromboangiitis obliterans: A review","volume":"11","author":"Castillo","year":"2024","journal-title":"Int. Surg. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"961","DOI":"10.4239\/wjd.v6.i7.961","article-title":"Peripheral artery disease in patients with diabetes: Epidemiology, mechanisms, and outcomes","volume":"6","author":"Thiruvoipati","year":"2015","journal-title":"World J. Diabetes"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Fazeli, B., Ligi, D., Keramat, S., Maniscalco, R., Sharebiani, H., and Mannello, F. (2021). Recent Updates and Advances in Winiwarter-Buerger Disease (Thromboangiitis Obliterans): Biomolecular Mechanisms. Diagnostics and Clinical Consequences. Diagnostics, 11.","DOI":"10.3390\/diagnostics11101736"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1080\/10408363.2025.2512472","article-title":"Association of inflammatory biomarkers with morbidity and mortality risk in patients with peripheral artery disease: A systematic review and meta-analysis","volume":"62","author":"Neves","year":"2025","journal-title":"Crit. Rev. Clin. Lab. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"15348","DOI":"10.1038\/s41598-024-65188-w","article-title":"An evaluation of inflammatory and endothelial dysfunction markers as determinants of peripheral arterial disease in those with diabetes mellitus","volume":"14","author":"Zaib","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Meloni, M., Izzo, V., Giurato, L., L\u00e1zaro-Mart\u00ednez, J.L., and Uccioli, L. (2020). Prevalence. Clinical Aspects and Outcomes in a Large Cohort of Persons with Diabetic Foot Disease: Comparison between Neuropathic and Ischemic Ulcers. J. Clin. Med., 9.","DOI":"10.3390\/jcm9061780"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Xie, H., Lu, J., Zheng, G., Liu, X., and Chen, W. (2025). Long-term outcomes and prognostic factors of major amputation in thromboangiitis obliterans after drug therapy and endovascular procedures: A real-world cohort study. Sci. Prog., 108.","DOI":"10.1177\/00368504251320766"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Song, Y., Zhao, Y., Shu, Y., Zhang, L., Cheng, W., Wang, L., Shu, M., Xue, B., Wang, R., and Feng, Z. (2023). Combination model of neutrophil to high-density lipoprotein ratio and system inflammation response index is more valuable for predicting peripheral arterial disease in type 2 diabetic patients: A cross-sectional study. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1100453"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S31","DOI":"10.4103\/sja.SJA_543_18","article-title":"The STROBE guidelines","volume":"13","author":"Cuschieri","year":"2019","journal-title":"Saudi J. Anaesth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S243","DOI":"10.1016\/S0167-5273(98)00175-2","article-title":"Diagnostic criteria of Buerger\u2019s disease","volume":"66","author":"Shionoya","year":"1998","journal-title":"Int. J. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee (2024). 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024. Diabetes Care, 47, S20\u2013S42.","DOI":"10.2337\/dc24-S002"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1259\/0007-1285-46-545-337","article-title":"The angiographic appearance of thromboangiitis obliterans (Buerger\u2019s disease) in the abdominal visceral vessels","volume":"46","author":"Rosenberger","year":"1973","journal-title":"Br. J. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"gfae069-0403","DOI":"10.1093\/ndt\/gfae069.403","article-title":"#1011 Clinical characteristics and outcomes of C3 glomerulopathy and immune complex MPGN from the UK National Registry of Rare Kidney Diseases (RaDaR)","volume":"39","author":"Masoud","year":"2024","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Vijayakumar, A., Tiwari, R., and Prabhuswamy, V. (2013). Thromboangiitis Obliterans (Buerger\u2019s Disease)\u2014Current Practices. Int. J. Inflamm.","DOI":"10.1155\/2013\/156905"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1186\/s12964-022-01016-w","article-title":"Common mechanisms underlying diabetic vascular complications: Focus on the interaction of metabolic disorders, immuno-inflammation, and endothelial dysfunction","volume":"21","author":"Xue","year":"2023","journal-title":"Cell Commun. Signal."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1016\/j.jdiacomp.2016.03.033","article-title":"Amputations and mortality in in-hospital treated patients with peripheral artery disease and diabetic foot syndrome","volume":"30","author":"Malyar","year":"2016","journal-title":"J. Diabetes Its Complicat."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Keller, K., Schmitt, V.H., Vosseler, M., Brochhausen, C., M\u00fcnzel, T., Hobohm, L., and Espinola-Klein, C. (2021). Diabetes Mellitus and Its Impact on Patient-Profile and In-Hospital Outcomes in Peripheral Artery Disease. J. Clin. Med., 10.","DOI":"10.3390\/jcm10215033"},{"key":"ref_23","first-page":"e220271","article-title":"Immunology of chronic low-grade inflammation: Relationship with metabolic function","volume":"257","year":"2023","journal-title":"J. Endocrinol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"8295","DOI":"10.2147\/JIR.S517693","article-title":"Association of Systemic Immune-Inflammatory Index with Risk of Foot Ulcer Amputation in Patients with Type 2 Diabetes Mellitus: Insights from a Cross-Sectional Study","volume":"18","author":"Huang","year":"2025","journal-title":"J. Inflamm. Res."},{"key":"ref_25","first-page":"1060","article-title":"Relationship between systemic immune inflammation index and amputation in patients with diabetic foot ulcer","volume":"29","author":"Eren","year":"2023","journal-title":"J. Orthop. Sci. Off. J. Jpn. Orthop. Assoc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"8","DOI":"10.4103\/tjem.tjem_198_23","article-title":"Unraveling the clinical significance and prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and delta neutrophil index: An extensive literature review","volume":"24","author":"Islam","year":"2024","journal-title":"Turk. J. Emerg. Med."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Cosma-L\u0103zuran, R., Leucu\u0163a, D., and Popoviciu, M. (2025). Systemic Immune-Inflammation Index and Related Hematologic Markers as Prognostic Tools in Type 2 Diabetes. Medicina, 61.","DOI":"10.3390\/medicina61081433"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Khalid, M., Petroianu, G., and Adem, A. (2022). Advanced Glycation End Products and Diabetes Mellitus: Mechanisms and Perspectives. Biomolecules, 12.","DOI":"10.3390\/biom12040542"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e70014","DOI":"10.1111\/1753-0407.70014","article-title":"Overview of oxidative stress and inflammation in diabetes","volume":"16","author":"Sibony","year":"2024","journal-title":"J. Diabetes"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s12933-023-02103-z","article-title":"Nonlinear relationship between untraditional lipid parameters and the risk of prediabetes: A large retrospective study based on Chinese adults","volume":"23","author":"Li","year":"2024","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s12933-025-02582-2","article-title":"Atherogenic index of plasma and coronary artery disease: A systematic review and meta-analysis of observational studies","volume":"24","author":"Assempoor","year":"2025","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1053\/j.semvascsurg.2019.02.001","article-title":"The diabetic foot: Pathophysiology, evaluation, and treatment","volume":"31","author":"Bandyk","year":"2018","journal-title":"Semin. Vasc. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1055\/a-2660-1858","article-title":"Thromboangiitis obliterans: An update 2025","volume":"150","author":"Stammler","year":"2025","journal-title":"Dtsch. Med. Wochenschr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s13047-020-00400-4","article-title":"Footwear and insole design features that reduce neuropathic plantar forefoot ulcer risk in people with diabetes: A systematic literature review","volume":"13","author":"Ahmed","year":"2020","journal-title":"J. Foot Ankle Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"20420188251362729","DOI":"10.1177\/20420188251362729","article-title":"Risk factor management over two decades in hospitalised patients with chronic limb-threatening ischaemia with and without diabetes mellitus","volume":"16","author":"Bodinger","year":"2025","journal-title":"Ther. Adv. Endocrinol. Metab."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1642","DOI":"10.1016\/j.jvs.2015.07.065","article-title":"The natural history of untreated severe or critical limb ischemia","volume":"62","author":"Steffen","year":"2015","journal-title":"J. Vasc. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Ruemenapf, G., Morbach, S., and Sigl, M. (2022). Therapeutic Alternatives in Diabetic Foot Patients without an Option for Revascularization: A Narrative Review. J. Clin. Med., 11.","DOI":"10.3390\/jcm11082155"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1177\/17085381231175257","article-title":"A comprehensive review of the epidemiology and clinical features of 91 cases with Buerger\u2019s disease","volume":"32","author":"Modaghegh","year":"2023","journal-title":"Vascular"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1161\/ATVBAHA.120.314595","article-title":"Epidemiology and Risk of Amputation in Patients With Diabetes Mellitus and Peripheral Artery Disease","volume":"40","author":"Barnes","year":"2020","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_40","first-page":"560","article-title":"Canadian Cardiovascular Society 2022 Guidelines for Peripheral Arterial Disease","volume":"38","author":"Abramson","year":"2022","journal-title":"Can. J. Cardiol."},{"key":"ref_41","first-page":"CD011033","article-title":"Pharmacological treatment for Buerger\u2019s disease","volume":"3","author":"Cacione","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1177\/1538574417744085","article-title":"Endovascular Treatment of Thromboangiitis Obliterans (Buerger\u2019s Disease)","volume":"52","author":"Modaghegh","year":"2018","journal-title":"Vasc. Endovasc. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Jia, G., Bai, H., Mather, B., Hill, M.A., Jia, G., and Sowers, J.R. (2024). Diabetic Vasculopathy: Molecular Mechanisms and Clinical Insights. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25020804"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/4\/560\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T12:14:01Z","timestamp":1770984841000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/4\/560"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,13]]},"references-count":43,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["diagnostics16040560"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16040560","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,13]]}}}