Peripheral vascular and nerve function associated with lower limb amputation in people with and without diabetes

Abstract

Multiple factors, including peripheral vascular disease and neuropathy, contribute to the development and perpetuation of complications of the lower extremities in diabetes. The main aim of the present study was to assess the peripheral vascular and nerve status of diabetic and non-diabetic subjects that had undergone lower limb amputation. Various non-invasive tests of peripheral vascular and nerve function were carried out on subjects who had undergone unilateral lower limb amputation and were now attending a Rehabilitation Centre. The control group (n=23), the diabetic amputee group (n=64) and the non-diabetic amputee group (n=32) were age-matched. Only the diabetic amputee group had evidence of medial arterial calcification. Transcutaneous oxygen levels were significantly lower in the diabetic amputee group (median 43 mmHg; interquartile range 33-49 mmHg) than in the control (59; 56-74 mmHg) and non-diabetic amputee (57; 43-65 mmHg) groups (control compared with diabetic amputee group, P<0.001; diabetic amputee compared with non-diabetic amputee group, P<0.01). The same trend was found for carbon dioxide levels in the skin [mmHg: diabetic amputees, 25 (21-37); controls, 38 (32-42); non-diabetic amputee, 34 (31-39)] (control compared with diabetic amputee, P<0.01; diabetic amputee compared with non-diabetic amputee, P<0.05). Vibration and pressure perception measurements (which assess Abeta nerve fibre function) showed that both the diabetic amputee and non-diabetic amputee subjects had significantly greater impairment than the controls. However, measures of Aalpha and C nerve fibre function were abnormal only in the diabetic amputee group. Thus the peripheral vascular and nerve functions of age-matched diabetic and non-diabetic subjects having undergone lower limb amputation show specific differences, with non-diabetic amputees exhibiting signs of neuropathy. This indicates that factors characteristic of diabetes (such as hyperglycaemia and non-enzymic glycation) are associated with calcification, lower oxygen and carbon dioxide levels in the skin, and abnormal Aalpha and C nerve fibre function.

The vascular and biochemical effects of cilostazol in patients with peripheral arterial disease

“…The TcpO 2 assessment was performed on the dorsum of each foot in the webspace between the first and second toes as well as on the chest wall as a reference lead using the TCM400 monitoring system (Radiometer, West Sussex, UK). 21 Biochemical assessment. Blood samples for full blood count, coagulation screen, electrolytes, and liver function tests were collected before exercise.…”

Calcification of the Medial Layer of the Internal Thoracic Artery in Diabetic Patients: Relevance of Glycoxidation

“…DM is a major risk factor for calcification of various arteries, including the aorta and coronary and peripheral arteries [2, 4, 5]. We speculate that medial calcification of the ITA is not visible on radiological examination because it is quite minimal (maximum calcification area 17.4%).…”

“…Medial calcification occurs in various arteries, such as the coronary arteries, aorta and peripheral arteries, in patients with DM and chronic renal failure [1, 2, 3, 4, 5]. Although medial calcification has been described in the inferior epigastric artery and radial artery in cases requiring arterial grafts for revascularization, it is not detected in the ITA even in these patients [9, 19, 20].…”

“…Medial calcification is a common feature of advanced arterial lesions, including coronary arterial, cerebrovascular and peripheral vascular diseases, and is enhanced in patients with hypertension, hemodialysis and diabetes mellitus (DM) [1, 2, 3]. Arterial calcification coexists and is associated with the severity of atherosclerosis of the aorta and coronary and peripheral arteries, and is a major cause of morbidity and mortality in patients with DM [4, 5].…”

Reliabilität der transkutanen Sauerstoffpartialdruckmessung an der unteren Extremität

“…Einige Studien scheinen die Validität und Intertest-Reliabilität des Verfahrens im Vergleich mit alternativen Messverfahren zu belegen [2,4,15,16]. Allerdings gibt es auch zahlreiche Studien, die auf eine hohe Variabilität der Messmethode hinweisen [17 ± 21].…”