Peripheral arterial disease (PAD) refers to atherosclerosis involving the aorta, the iliac artery, and the lower extremity arteries. The major risk factors for PAD are also common to other atherosclerotic diseases. They include smoking, diabetes mellitus (DM), renal failure, dyslipidemia, and aging.1,2 The natural course of chronic disease is difficult to predict. Symptoms do not always progress gradually from the severity to the next. Approximately half of patients suffering from critical ischemia have previously suffered symptoms of claudication and the first symptoms might be pain at rest and/or ulcers. DM is strongly associated with PAD. Among people with diabetes, PAD rate shows to be 11% compared with 4% among those without diabetes.3,4 Critical limb ischemia portends a severe diminution in quality of life and is associated to a high rate of amputation and a marked increase in short- term mortality.5-9