Comparative histological study of atherosclerotic lesions and microvascular changes in amputated lower limbs of diabetic and non-diabetic patients

Abstract

Objetive: to perform a comparative analysis of atherosclerotic lesions and capillaries changes in diabetic and nondiabetic patients. Methods: leg arteries and skin of 57 amputated lower limbs of diabetic (47.3%) and nondiabetic patients were histologically examined. the percentage of arterial stenosis of infrapopliteal arteries and the histological classification of atherosclerotic lesions were determined. capillary thickening was classified into four categories. Results: diabetic group showed more than 75% stenosis in 57% (vs. 56% in nondiabetic) of the anterior tibial; 78% (vs. 68%) of the posterior tibial; 58% (vs. 50%) of the peroneal leg arteries. diabetic and nondiabetic patients have predominance of type vi atherosclerotic lesions. the comparison of both groups showed no significant differences in atherosclerotic lesions. diabetic patients had significantly more PAs positive capillary thickening (63% vs. 23%). Conclusions: there were no differences in histological characteristics of atherosclerosis between the two groups. capillary thickening has been more observed in diabetics. RESUMO Estudo Histológico Comparativo das Lesões Ateroscleróticas e Alterações Microvasculares em Membros Inferiores Amputados de Pacientes Diabéticos e Não-diabéticos.Objetivo: comparar as lesões ateroscleróticas das extremidades de diabé-ticos e não-diabéticos, estudando a ocorrência de espessamento capilar. Métodos: examinou-se segmentos arteriais e da derme de 57 membros inferiores amputados de diabéticos (47,3%) e não-diabéticos. Analisou-se a porcentagem de estenose das artérias infra-poplíteas e a classificação histológica da placa. A presença de espessamento capilar foi classificada em quatro categorias. Resultados: entre os diabéticos 57% (versus 56% dos não-diabéticos) apresentavam estenose maior que 75% da artéria tibial anterior; 78% (versus 68%) da tibial posterior; 58% (versus 50%) da fibular. Houve predominância em ambos de lesões ateroscleróticas do tipo vi. comparando os grupos, não houve diferença significante na porcentagem de obstrução arterial ou na classificação da placa aterosclerótica. os diabéticos apresentaram significativamente mais espessamento capilar (63% versus 23%). Conclusões: não houve diferença nas características das lesões ateros cle róticas em diabéticos e não-diabéticos. o espessamento capilar foi mais prevalente entre os diabéticos.

Mulberry branch bark powder significantly improves hyperglycemia and regulates insulin secretion in type II diabetic mice

“…Sustained high level of blood sugar can lead to microvascular lesions and cause circulation disorders in the liver [28]. ALT and AST are important indicators of liver function.…”

Análise das arteriografias de diabéticos e não diabéticos com isquemia crítica da perna

“…19,20 The higher prevalence of hypertension among diabetic patients with PAOD found in our sample has also been mentioned by other authors. 6,18,21 As for the arterial territory affected by PAOD, diagnosed by physical examination of pulses, most of our patients in both groups had femoropopliteal disease. The infrapatellar disease, with normal popliteal pulse was little prevalent in our sample and the difference was not significant between diabetics and nondiabetics.…”

“…However, when comparing the groups, females were statistically more prevalent among diabetics, as shown in studies by other authors who focused on diabetic foot complications. 5,[16][17][18] This finding may be explained by a parallel with coronary heart disease, in which the protective effect of the female sex is eliminated by diabetes, as well as the fact that diabetes doubles the risk of cardiovascular disease in men and triples it in women. 19,20 The higher prevalence of hypertension among diabetic patients with PAOD found in our sample has also been mentioned by other authors.…”

“…8,18,22 However, histological studies have shown that atherosclerotic lesions in the lower limbs appear to have indistinguishable morphology and distribution in both groups. 18,23 Our study found no differences in the angiographic patterns of diabetic and nondiabetic patients in relation to opacification of the leg arteries, except for the PT artery, with both groups having similar behavior in relation to the number of visualized arteries. However, other authors, who also performed arteriographic studies, showed differences between diabetic and nondiabetic patients, reporting that diabetics have greater infrapatellar involvement by atherosclerotic disease.…”

“…In the 1960s, the anatomopathological study by Strandness et al 26 found that diabetics had the PT, AT and fibular arteries more frequently affected than nondiabetic patients, whereas other histological studies showed a similar pattern of atherosclerotic disease between diabetics and nondiabetics. 18,[27][28][29] While the arteriographic studies do not determine the morphological characteristics of the atherosclerotic plaque and may fail to detect it, either due to the examination technique or the presence of lesions that do not lead to significant stenoses, 30 histological studies often do not analyze the entire length of the artery in question, but only sections of selected fragments.…”