A comparison of Doppler ankle pressures and skin perfusion pressure in subjects with and without diabetes

Quigley, Frank; Faris, Irwin; Duncan, H. J.

doi:10.1111/j.1475-097x.1991.tb00650.x

Cited by 54 publications

(41 citation statements)

References 6 publications

(9 reference statements)

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“…There are conflicting reports about skin capillary blood flow in the diabetic foot. Some studies have reported the absence of alterations in capillary blood circulation in neuropathic diabetics [18,19], while others observed a marked reduction in capillary blood perfusion in diabetic patients with or without peripheral arterial disease [20][21][22][23]. This suggests the presence of microangiopathy of the capillaries in diabetic patients with foot ulcer but does not confer any typical characteristics to patients with neuropathy alone or with peripheral vascular disease.…”

Section: Discussionmentioning

confidence: 83%

Prospective study on microangiopathy in type 2 diabetic foot ulcer

et al. 2016

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Aims/hypothesis We investigated the significance of microangiopathy in the development of foot ulcer, which is still disputed. Methods We assessed microangiopathy by histological analysis of the capillary ultrastructure using transmission electron microscopy and capillary density and arteriolar morphology in paraffin-embedded sections from the skin of type 2 diabetic patients: 30 neuroischaemic patients (Isc) revascularised with peripheral angioplasty and 30 neuropathic patients (Neu) with foot ulcer, compared with ten non-diabetic volunteers. Results In the diabetic patients, capillaries in the dermal papillary layer were fewer (−22.2%, 159 ± 43 vs 205 ± 52 mm 2 in non-diabetic volunteers, p < 0.01). They also showed detrimental remodelling, with a 2.2-fold increase in capillary basement membrane thickness (3.44 ± 1.19 vs 1.53 ± 0.34 μm in non-diabetic volunteers, p < 0.001) and a 57.7% decrease in lumen area (14.6 ± 11.1 vs 34.7 ± 27.5 μm 2 , p < 0.001). No differences were observed between the diabetic Isc or Neu patients. Isc were more prone to develop arteriolar occlusion than Neu (16.8 ± 6.9% vs 6.7 ± 3.7%, respectively, p < 0.001).No patient had been amputated at 30 days and healing time was significantly longer in Isc (180 ± 120 vs 64 ± 50 days in Neu, p < 0.001). Conclusions/interpretation Capillary microangiopathy is present in equal measure in neuroischaemic and neuropathic diabetic foot skin. The predominance of arteriolar occlusions with neuroischaemia indicated the existence of an additional 'small vessel disease' that did not affect an effective revascularisation and did not worsen the prognosis of major amputations but slowed the healing process of the neuroischaemic foot ulcer. Trial registration: ClinicalTrials.gov NCT02610036.

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Section: Discussionmentioning

confidence: 83%

Prospective study on microangiopathy in type 2 diabetic foot ulcer

et al. 2016

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“…Very interestingly, this finding was independent of the presence of diabetes mellitus and renal insufficiency, factors known to be associated with both falsely high ABI values and risk of amputation. 2,4,12,20,21 A link between high ABI and poor outcome was found also in the Strong Heart Study, 17,18 which investigated a population with a high prevalence of diabetes mellitus. By contrast, results from the Atherosclerotic Risk in Communities Study 22 indicate that in general population with a low prevalence of PAD, those with a high ABI (Ͼ 1.3) do not suffer greater cardiovascular event rates than those with a normal ABI (0.9-1.3).…”

Section: Discussionmentioning

confidence: 99%

“…1 The relation of low ankle pressure to major amputation is lost among patients with ischemic foot lesion. 1 This is in part due to the fact that patients with CLI and ischemic lesions often have diabetes mellitus and are older, 3 factors known to cause medial arterial calcification (MAC), 11,12 which reduces the arterial compressibility and, thus, impairs the reliability of ankle pressure measurement. In these patients, alternative tests are needed to estimate the degree of circulatory impairment and prognosis.…”

Section: Introductionmentioning

confidence: 99%

Falsely high ankle-brachial index predicts major amputation in critical limb ischemia

et al. 2006

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Falsely high ankle-brachial index (ABI) values are associated with an adverse clinical outcome in diabetes mellitus. The aim of the present study was to verify whether such an association also exists in patients with chronic critical limb ischemia (CLI) with and without diabetes. A total of 229 patients (74 ± 11 years, 136 males, 244 limbs with CLI) were followed for 262 ± 136 days. Incompressibility of lower limb arteries (ABI > 1.3) was found in 45 patients, and was associated with diabetes mellitus ( p = 0.01) and renal insufficiency ( p = 0.035). Limbs with incompressible ankle arteries had a higher rate of major amputation ( p = 0.002 by log-rank). This association was confirmed by multivariate Cox regression analysis (relative risk [RR] 2.67; 95% CI 1.27-5.64, p = 0.01). The relationship between ABI > 1.3 and amputation rate persisted after subjects with diabetes and renal insufficiency had been removed from the analysis (RR 3.85; 95% CI 1.25-11.79, p = 0.018). Dividing limbs with measurable ankle pressure according to tertiles of ABI, the group in the second tertile (0.323 ≤ ABI ≤ 0.469) had the lowest amputation rate (4/64, 6.2%), and a U-shaped association between the occurrence of major amputation and ABI was evident. No association was found between ABI and mortality. In conclusion, this study demonstrates that falsely high ABI is an independent predictor of major amputation in patients with CLI.

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“…Low ABI measurements (< 0.90) have been studied as a marker of atherosclerotic peripheral arterial disease (PAD) for over 40 years [1]. PAD is commonly assessed by the measurement of ABI [2].…”

Section: Introductionmentioning

confidence: 99%

Relation of Ankle Brachial Index to Left Ventricular Ejection Fraction in Diabetic Patients

Abbasnezhad

2012

J Endocrinol Metab

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Background: Peripheral arterial disease is associated with an excessive risk for cardiovascular events and mortality. It is usually measured with ankle brachial index (ABI), which is shown to be influenced by left ventricular ejection fraction (LVEF) independent of coronary disease. Diabetics significantly have higher risk for cardiovascular disease. The aim of current study is to evaluate relation of ABI to LVEF in diabetic patients.

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A comparison of Doppler ankle pressures and skin perfusion pressure in subjects with and without diabetes

Cited by 54 publications

References 6 publications

Prospective study on microangiopathy in type 2 diabetic foot ulcer

Prospective study on microangiopathy in type 2 diabetic foot ulcer

Falsely high ankle-brachial index predicts major amputation in critical limb ischemia

Relation of Ankle Brachial Index to Left Ventricular Ejection Fraction in Diabetic Patients

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