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Program for 1998 Spring Meeting

#13. CUTANEOUS MICROCIRCULATION IN THE NEUROPATHIC DIABETIC FOOT IMPROVES SIGNIFICANTLY BUT NOT COMPLETELY AFTER SUCCESSFUL LOWER EXTREMITY REVASCULARIZATION

 

Subodh Arora, MD, Aristidis Veves, MD, Paula Smakowski, PT,

Frank B. Pomposelli, MD, Louis Simeone, DPM, Hau Pham, DPM,

and Frank W. Logerfo, MD.

 

Beth Israel Deaconness Medical Center-Harvard Medical School,

Boston, MA.

 

Purpose: To study the effect of successful lower extremity revascularization (LER) on the cutaneous microcirculation of the neuropathic and ischemic diabetic foot.

Methods: Thirteen patients with diabetic neuropathy and lower extremity ischemia (DI group, 11 males, age 62 ± 3 years, mean ± SE, DM duration 20 ± 3 years) were tested before and 2-4 weeks after LER and were compared to 15 diabetic patients (D, 5M, age 55 ± 6, DM duration 15 ± 4) and 12 healthy controls (C, 8M, age 58 ± 3 years). Single point and laser Doppler imaging scanner was employed to measure the foot cutaneous vasodilation in response to heating to 44¡C and to iontophoresis of 1% acetylcholine (Ach, endothelium dependent) and 1% sodium nitroprusside (NaNP, endothelium independent).

Results: (vasodilatory response expressed a % increase over baseline, mean ± SE)

DI preop DI postop DN D C P

 

Response to 289 ± 90 427 ± 61 318 ± 51 766 ± 220 891 ± 121 DI pre vs. DI post

heat vs. D, C: p<0.05

Response to 6 ± 4 26 ± 8 18 ± 3 38 ± 8 48 ± 9 DI pre vs. DI post

Ach vs. C: p<0.05

Response to 10 ± 4 29 ± 9 25 ± 9 32 ± 6 40 ± 5 DI pre vs. DI post:

NaNP p, 0.05

Neurovascular 5 ± 9 14 ± 10 33 ± 21 110 ± 40 198 ± 54 DI pre, DI post, DN

response vs. D, C: p<0.001

Conclusions: Impaired cutaneous vasodilation in the ischemic and neuropathic diabetic foot improves significantly but is not fully corrected by successful LER. LER in diabetic neuropathic patients significantly restores microcirculatory physiology but some impairment remains, leaving the foot at increased risk for ulceration.

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Last updated August 18, 1998