Sympathetic Function Test of Vasoconstrictor Changes in Foot Arteries in Diabetic Patients

Takahashi, Tatsuji; Nishizawà, Yoshiki; Emoto, Masanori; Kawagishi, Takahiko; Matsumoto, Naoki; Ishimura, Eiji; Inaba, Masaaki; Okuno, Yasuhisa; Shimada, Hiroyuki; Morii, Hirotoshi

doi:10.2337/diacare.21.9.1495

Cited by 13 publications

(9 citation statements)

References 33 publications

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“…These studies have confirmed the hypothesis of a hyperperfusion state in the lower extremities at an arteriovenous shunt volume that was increased up to threefold due to opening of the sympathetically controlled resistance vessels (7,10). Furthermore, other workers reported a reduction in the response to sympathetic stimulation (10,11). In ϳ50% of a cohort of diabetic patients, an abnormal skin blood flow has been observed at the index finger and a nondiscernible decrease or abnormal latencies after stimulation was reported (9).…”

supporting

confidence: 67%

“…This technique can be applied under conditions at rest and during sympathetic stimulation by means of a deep inspiratory gasp (10) or an electric stimulus (9). Alternatively, venous plethysmography (6) and duplex Doppler sonography (11) have been used. These studies have confirmed the hypothesis of a hyperperfusion state in the lower extremities at an arteriovenous shunt volume that was increased up to threefold due to opening of the sympathetically controlled resistance vessels (7,10).…”

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confidence: 99%

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Sympathetic Vasomotor Response of the Radial Artery in Patients With Diabetic Foot Syndrome

et al. 2003

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ANJA VICTOR, BS 5OBJECTIVE -Neurophysiological assessment of the peripheral autonomic system is characterized by various limitations. An alternative approach to laser Doppler and venous plethymography is the assessment of the sympathetic vasomotor response of the radial artery obtained by continuous wave Doppler sonography. Nomogram data have been established and demonstrate the temporary disappearance of diastolic flow after coughing or deep inspiration. RESEARCH DESIGN AND METHODS -We assessed the sympathetic vasomotor response in 25 patients (mean age 64 years, range 43-76) with diabetic foot syndrome. The Doppler data were correlated with nerve conduction studies of the median and peroneal nerve, the extent of radiologically diagnosed media sclerosis, and compared with nomogram values (n ϭ 41).RESULTS -Although similar mean flow velocities were found under baseline conditions, the flow pattern was characterized by higher pulsatility in the diabetic group (resistance index [RI] 1.1 vs. 0.7). No significant difference in RI was observed after coughing. The latency of onset of the response was prolonged (2.1 vs. 1.5 s), while the duration of the response did not differ (18 vs. 15 s). Only the nerve conduction velocity of the peroneal nerve correlated inversely with the RI. The extent of radiologically proven calcification tended to correlate with the pulsatility of the baseline signal and the response latencies.CONCLUSIONS -The data obtained by this study suggest the concurrent existence of reduced vessel elasticity due to media sclerosis and dysfunction of the autonomic vasomotor system. Diabetes Care 26:2616 -2621, 2003A utonomic neuropathy is a frequent complication in diabetes and one of the major causes of cardiovascular death. Mortality rates vary from a 60% 5-year mortality (1) to a 10% 10-year mortality (2) and are about three times as high as in patients with neuropathy without clinical evidence of autonomic involvement (3). While extensive tests for cardiovascular autonomic functions are readily available (4,5), they may be of little help in the diagnosis of peripheral autonomic dysfunction (6). To date, laser Doppler flowmetry, which enables assessment of the capillary and arteriovenous blood flow, represents the most reliable test for the diagnosis of peripheral autonomic dysfunction (7-9). This technique can be applied under conditions at rest and during sympathetic stimulation by means of a deep inspiratory gasp (10) or an electric stimulus (9). Alternatively, venous plethysmography (6) and duplex Doppler sonography (11) have been used. These studies have confirmed the hypothesis of a hyperperfusion state in the lower extremities at an arteriovenous shunt volume that was increased up to threefold due to opening of the sympathetically controlled resistance vessels (7,10). Furthermore, other workers reported a reduction in the response to sympathetic stimulation (10,11). In ϳ50% of a cohort of diabetic patients, an abnormal skin blood flow has been observed at the index finger and a nondiscernible d...

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confidence: 99%

Sympathetic Vasomotor Response of the Radial Artery in Patients With Diabetic Foot Syndrome

et al. 2003

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“…First, the autonomic denervation is believed to develop MAC (30) and could be biologically linked to arterial wall stiffness. Second, however, sympathetic failure affects microvascular blood flow by continuously opening arteriovenous shunts and increasing flow volume (31). It may be important that a concomitant abnormality, such as basement membrane thickness, regulates vascular resistance to blood flow, although there was no explanation for microangiopathy as a determinant factor of flow volume in the present study (32).…”

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confidence: 49%

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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“…Little is known about the length dependence of the effects of diabetes on autonomic neurons. However, because deficits in sympathetic nerve-mediated vasoconstriction of arteries supplying skin of the hands and feet can be an early sign of diabetic autonomic neuropathy (13,35), sympathetic neurons with long axons may also be particularly susceptible to the effects of diabetes. In rat tail artery, STZinduced diabetes is reported to produce a length-dependent increase in the neuronal content of biogenic amines (norepinephine, adrenaline, serotonin, and dopamine), with the most marked changes occurring in the most distal region of this vessel (20).…”

Section: Discussionmentioning

confidence: 99%

“…These studies have demonstrated that both type 1 (insulin dependent) and type 2 (noninsulin dependent) diabetic patients with signs of sensory and/or autonomic neuropathy (e.g., orthostatic hypertension) have increased skin blood flow under basal conditions (2,33) and attenuated reductions in skin blood flow (i.e., vasoconstriction) in response to sympathetic arousal [e.g., produced by mental arithmetic (2) or postural stimuli (29)]. Importantly, deficits in sympathetic vasoconstriction of arterial vessels supplying plantar skin can be demonstrated in both type 1 and type 2 diabetic patients at an early phase of diabetic neuropathy (31,35), perhaps suggesting that sympathetic neurons supplying these vessels are particularly vulnerable to the effects of diabetes. Furthermore, it has been suggested that reduced sympathetic nerve-mediated vasoconstriction of these vessels is an early change that contributes to the etiology of microangiopathy in skin of the feet (7).…”

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confidence: 99%

Streptozotocin-induced diabetes differentially affects sympathetic innervation and control of plantar metatarsal and mesenteric arteries in the rat

Johansen

Tripovic

Brock

2013

American Journal of Physiology-Heart and Circulatory Physiology

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Johansen NJ, Tripovic D, Brock JA. Streptozotocin-induced diabetes differentially affects sympathetic innervation and control of plantar metatarsal and mesenteric arteries in the rat. Am J Physiol Heart Circ Physiol 304: H215-H228, 2013. First published November 16, 2012; doi:10.1152/ajpheart.00661.2012.-In humans neural control of arterial vessels supplying skin in the extremities is particularly vulnerable to the effects of diabetes. Here the streptozotocin (STZ) rat model of type 1 diabetes was used to compare effects on neurovascular function in plantar metatarsal arteries (PMAs), which supply blood to skin of hind paw digits, with those in mesenteric arteries (MAs). Twelve weeks after STZ (60 mg/kg ip), wire myography was used to assess vascular function. In PMAs, lumen dimensions were unchanged but both nerve-evoked contractions and sensitivity to ␣1 (phenylephrine, methoxamine)-and ␣2 (clonidine)-adrenoceptor agonists were reduced. The density of perivascular nerve fibers was also reduced by ϳ25%. These changes were not observed in PMAs from STZ-treated rats receiving either a low dose of insulin that did not greatly reduce blood glucose levels or a high dose of insulin that markedly reduced blood glucose levels. In MAs from STZ-treated rats, nerve-evoked increases in force did not differ from control but, because lumen dimensions were ϳ20% larger, nerveevoked increases in effective transmural pressure were smaller. Increases in effective transmural pressure produced by phenylephrine or ␣,␤-methylene ATP in MAs from STZ-treated rats were not smaller than control, but the density of perivascular nerve fibers was reduced by ϳ10%. In MAs, the increase in vascular dimensions is primarily responsible for reducing effectiveness of nerve-evoked constrictions. By contrast, in PMAs decreases in both the density of perivascular nerve fibers and the reactivity of the vascular muscle appear to explain impairment of neurovascular transmission. diabetes; sympathetic innervation; neurovascular transmission IN HUMANS ABNORMAL CONTROL of the vasculature has been implicated in the etiology of many diabetes-related complications such as neuropathy and diabetic foot ulceration (41). These changes involve endothelium-dysfunction (30) as well as deficits in both sympathetic nerve-mediated vasoconstriction (see below) and sensory nerve-mediated vasodilation (1). However, the mechanisms whereby diabetes affects sympathetic and sensory nerve regulation of the vasculature are not well understood, although it is believed that diabetes causes degeneration of these nerve supplies (34).Many clinical studies have evaluated the effects of diabetes on sympathetic nerve-mediated vasoconstriction of arterial vessels supplying plantar skin of the foot. These studies have demonstrated that both type 1 (insulin dependent) and type 2 (noninsulin dependent) diabetic patients with signs of sensory and/or autonomic neuropathy (e.g., orthostatic hypertension) have increased skin blood flow under basal conditions (2, 33) and attenuated reductions i...

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Sympathetic Function Test of Vasoconstrictor Changes in Foot Arteries in Diabetic Patients

Abstract: We conclude that the %RI of the digital artery is a useful and reliable sympathetic function test of early phase in diabetic patients.

Cited by 13 publications

References 33 publications

Sympathetic Vasomotor Response of the Radial Artery in Patients With Diabetic Foot Syndrome

Sympathetic Vasomotor Response of the Radial Artery in Patients With Diabetic Foot Syndrome

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

Streptozotocin-induced diabetes differentially affects sympathetic innervation and control of plantar metatarsal and mesenteric arteries in the rat

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