Fig. 1

Progression of atherosclerotic calcification in diabetic foot patients. (1) In gross observation, different degrees of gangrene, swelling, skin ulcers, and infection in diabetic foot patients among the three groups were observed. (2) Ultrasound showed that echo-rich plaques (hard plaques) were the majority in the moderate stenosis/severe stenosis/occlusion group, whereas echolucent/heterogeneous plaques (soft/heterogeneous plaques) were predominant in the mild stenosis group. Furthermore, color blood flow in the severe stenosis/occlusion group became thin even in the absence of blood flow signal by CDFI. (3, 4) Representative photomicrographs of atherosclerotic lesions in anterior tibial artery cross-sections after H&E staining (×40) and von Kossa staining (black calcium particles) (×200). von Kossa staining revealed extensive calcification lesions in the intima and media of the anterior tibial artery. The extent and area of the calcium deposition in the intima became significantly more severe with disease progression. Spotty calcification was predominant in the atherosclerotic plaques of diabetic patients with amputation, whereas macrocalcification was almost invisible