Angiographic Evaluation of Peripheral Arterial Occlusive Disease and Its Role as a Prognostic Determinant for Major Amputation in Diabetic Subjects With Foot Ulcers

Faglia, Ezio; Favales, Fabrizio; Quarantiello, Antonella; Calia, Patrizia; Clelia, Paratore; Brambilla, Giorgio; Rampoldi, Antonio; Morabito, Alberto

doi:10.2337/diacare.21.4.625

Cited by 126 publications

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“…Contrast angiography has been used to evaluate the severity of morphologic changes in peripheral arteries but is frequently limited for several reasons, including possible nephrotoxity from contrast medium (4). Other reasons include the invasiveness of the procedure itself, associated risks, and costs (4).…”

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confidence: 99%

Increased Arterial Wall Stiffness Limits Flow Volume in the Lower Extremities in Type 2 Diabetic Patients

et al. 2001

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OBJECTIVE—To document an association between arterial wall stiffness and reduced flow volume in the lower-extremity arteries of diabetic patients. RESEARCH DESIGN AND METHODS—We recruited 60 consecutive type 2 diabetic patients who had no history or symptoms of peripheral arterial disease (PAD) in the lower extremities and normal ankle/brachial systolic blood pressure index at the time of the study (non-PAD group) and 20 age-matched nondiabetic subjects (control group). We used an automatic device to measure pulse wave velocity (PWV) in the lower extremities as an index of arterial wall stiffness. At the popliteal artery, we evaluated flow volume and the resistive index as an index of arterial resistance to blood flow using gated two-dimensional cine-mode phase-contrast magnetic resonance imaging. RESULTS—Consistent with previous reports, we confirmed that the non-PAD group had an abnormally higher PWV compared with that of the control group (P < 0.001). To further demonstrate decreased flow volume and abnormal flow pattern at the popliteal artery in patients with a higher degree of arterial wall stiffness, we assigned the 60 non-PAD patients to tertiles based on their levels of PWV. In the highest group, magnetic resonance angiograms of the calf and foot arteries showed decreased intravascular signal intensity, indicating the decreased arterial inflow in those arteries. The highest group was also characterized by the lowest late diastolic and total flow volumes as well as the highest resistive index among the groups. From stepwise multiple regression analysis, PWV and autonomic function were identified as independent determinants for late diastolic flow volume (r2 = 0.300; P < 0.001). CONCLUSIONS—Arterial wall stiffness was associated with reduced arterial flow volume in the lower extremities of diabetic patients.

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Increased Arterial Wall Stiffness Limits Flow Volume in the Lower Extremities in Type 2 Diabetic Patients

et al. 2001

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“…The detection of significant arterial disease is vital to the prevention and treatment of foot disease. The unreliable nature of the symptoms and signs of lower-limb arterial insufficiency in diabetes means that noninvasive tests are essential to achieve effective screening (2,3). The European Working Group on Critical Leg Ischaemia recommends an additional, noninvasive vascular assessment for patients with diabetes and foot ulceration (4).…”

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An Evaluation of the Efficacy of Methods Used in Screening for Lower-Limb Arterial Disease in Diabetes

2005

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OBJECTIVE -Foot-related disease is the most common cause for hospital admission among the diabetic population. Lower-limb peripheral arterial occlusive disease (PAOD) is a major risk factor in diabetic foot disease. Screening for PAOD commonly includes foot pulses and the ankle-brachial pressure index (ABPI) and/or the toe-brachial pressure index (TBI), but concerns persist regarding their accuracy. We evaluated the efficacy of several commonly used screening methods in different subject populations.RESEARCH DESIGN AND METHODS -We studied 130 limbs in 68 individuals with no critical ischemia over 8 months. Limbs were grouped on the basis of the presence or absence of diabetes, clinically detectable peripheral neuropathy, and PAOD identified on color duplex imaging. Comparative analyses of foot pulses, the ABPI, the TBI, and distal Doppler waveform analysis were performed.RESULTS -Foot pulses, the TBI, and qualitative waveform analyses were highly sensitive screening methods in individuals with and without diabetes. However, detectable peripheral neuropathy was associated with a reduced sensitivity and poor specificity of foot pulses, a reduction in sensitivity of the ABPI (71 to 38%), and a reduction in specificity of the TBI (81 to 61%) and qualitative waveform analysis (96 to 66%). Quantitative analysis failed to detect disease with severely damped and low-intensity signals.CONCLUSIONS -Screening tools that are effective in screening for lower-limb PAOD in the nondiabetic population are less efficacious in diabetes, particularly in the presence of detectable peripheral neuropathy. Qualitative waveform analysis and the TBI were demonstrated to be more effective screening methods than the ABPI and foot pulses particularly in high-risk limbs with detectable peripheral neuropathy. Diabetes Care 28:2206 -2210, 2005F oot-related disease is the most common cause for hospital admission among the diabetic population and is recognized as the most common cause of nontraumatic lower-limb amputation in the western world. People with diabetes are Ͼ20 times more likely to undergo an amputation than the rest of the population (1). The main risk factors for the development of diabetic foot disease are peripheral neuropathy and peripheral arterial occlusive disease (PAOD). The detection of significant arterial disease is vital to the prevention and treatment of foot disease. The unreliable nature of the symptoms and signs of lower-limb arterial insufficiency in diabetes means that noninvasive tests are essential to achieve effective screening (2,3). The European Working Group on Critical Leg Ischaemia recommends an additional, noninvasive vascular assessment for patients with diabetes and foot ulceration (4).Screening techniques commonly used in assessing lower-limb perfusion are the palpation of foot pulses and calculation of the ankle-brachial pressure index (ABPI) and/or the toe-brachial pressure index (TBI). There is continued debate regarding the influence of peripheral neuropathy and arterial calcification on the reliabil...

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“…Studijoje, kurioje arteriografiniai duomenys pasirinkti kaip kontrolė, hemodinamiškai reikšmingi arterijų susiaurėjimai > 50 proc. yra aptinkami cukriniu diabetu sergantiems pacientams su palpuojamais pulsais pėdoje ir KŽI > 1, t. y. rodančiu nesutrikusią arterinę kraujotaką galūnėje [25]. Todėl pacientams, kurių simptomai ir požymiai (protarpinis šlubčiojimas, ramybės būsenos skausmas, pėdos pulsų nebuvimas) tinka PAOL, taip pat nustatomi monofaziniai Doplerio signalai, KŽI < 0,9, turėtų būti nukreipiami į kraujagyslių chirurgo konsultaciją [23].…”

Section: Paol Ir Kki Diagnostikaunclassified

“…Tačiau žemiau kelio arterijų atliktų šuntavimo operacijų šiomis medžiagomis išeičių metaanalizė rodo, kad rezultatai yra prasti. 5 metų veikimo dažnis yra tik [19][20][21][22][23][24][25][26][27][28][29][30] teorija ir praktika 2014 -T. 20 (Nr. 4) procentų, priklausomai nuo šunto medžiagos (atšaldytos ir užšaldytos venos, virkštelės venos, užšaldytos arterijos), o pėda išsaugota tik 55-60 proc.…”

Section: Medikamentinė Terapija Antikoaguliantaiunclassified

Periferinių Arterijų Okliuzinės Ligos Ypatumai Sergant Cukriniu Diabetu: Literatūros Apžvalga

Navickienė¹,

Builytė²

2014

Medicinos Teorija Ir Praktika

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Reikšminiai žodžiai: cukrinis diabetas, periferinių arterijų okliuzinė liga, arterijų rekonstrukcija. Viena didžiausių senstančios visuomenės problemų yra aterosklerozė ir cukrinio diabeto sukeltos komplikacijos. Aterosklerozės klinikinės išraiškos yra išeminė širdies liga, galvos smegenų išemija ir periferinių arterijų okliuzinė liga. Cukrinis diabetas, amžius, rūkymas ir lytis yra svarbiausi rizikos veiksniai periferinių arterijų okliuzinei ligai išsivystyti ir progresuoti. Atlikta daugelis studijų, nagrinėjančių periferinių arterijų okliuzinės ligos progresavimą, tačiau iki šiol tyrimai negali pateikti vienareikšmio atsakymo, kokie rizikos veiksniai yra svarbiausi ir turi daugiausia įtakos periferinių arterijų okliuzinės ligos vystymuisi sergančių cukriniu diabetu pacientų grupėje. Šiame straipsnyje apibendriname svarbiausius gretutinius rizikos veiksnius, ligos ypatumus, klinikinius ligos pasireiškimus, pagrindinius diagnostikos ir gydymo pasirinkimo metodus pacientams, sergantiems cukriniu diabetu ir periferinių arterijų okliuzine liga. Metodai. Surinkta ir apibendrinta literatūra, apžvelgianti periferinių arterijų okliuzinės ligos pasireiškimą, diagnostikos ir gydymo metodus pacientams, sergantiems cukriniu diabetu. Išvados. Būtini tolesni randomizuoti tyrimai, kurie leistų sudaryti gydymo algoritmą pacientams, sergantiems cukriniu diabetu ir periferinių arterijų okliuzine liga.

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Angiographic Evaluation of Peripheral Arterial Occlusive Disease and Its Role as a Prognostic Determinant for Major Amputation in Diabetic Subjects With Foot Ulcers

Abstract: Angiography permits an exact detection of occlusive arterial disease in subjects with normal results for noninvasive vascular procedures. A score that has a relevant prognostic value for major amputation can be obtained from the evaluation of the extent and diffusion of the stenoses.

Cited by 126 publications

References 0 publications

Increased Arterial Wall Stiffness Limits Flow Volume in the Lower Extremities in Type 2 Diabetic Patients

Increased Arterial Wall Stiffness Limits Flow Volume in the Lower Extremities in Type 2 Diabetic Patients

An Evaluation of the Efficacy of Methods Used in Screening for Lower-Limb Arterial Disease in Diabetes

Periferinių Arterijų Okliuzinės Ligos Ypatumai Sergant Cukriniu Diabetu: Literatūros Apžvalga

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