Atherothrombosis in diabetes--its evolution and management

Arteriographic findings in diabetic and non-diabetic with critical limb ischemia

OBJECTIVE

To compare angiographic findings of diabetic and non-diabetic patients with critical limb ischemia.

METHODS

We included 161 patients with infrainguinal critical limb ischemia (CLI). We evaluated the clinical and arteriographic (number and presence of opacification of leg arteries) of the two groups of patients. Statistical analysis was performed using EPI-INFO.

RESULTS

Most patients were category 5 of Rutherford's Classification and had femoropopliteal disease. Seventy-two percent of non-diabetic and 67% of diabetic had opacification of the fibular artery (p = 0.25), this is the most present artery in both groups. Diabetic patients had less opacification of the posterior tibial artery in the univariate analysis (29% vs. 47%, p = 0.008). But only female sex showed a significant risk for the absence of the posterior tibial artery in logistic regression (OR = 2.6; p = 0.01).

CONCLUSION

The peroneal artery was the most frequently artery in angiograms of diabetic and non-diabetic patients with CLI. Diabetic and non-diabetic patients did not differ in angiographic findings of the leg.

Comparative histological study of atherosclerotic lesions and microvascular changes in amputated lower limbs of diabetic and non-diabetic patients

OBJETIVE: To perform a comparative analysis of atherosclerotic lesions and capillaries changes in diabetic and nondiabetic patients. METHODS: Leg arteries and skin of 57 amputated lower limbs of diabetic (47.3%) and nondiabetic patients were histologically examined. The percentage of arterial stenosis of infrapopliteal arteries and the histological classification of atherosclerotic lesions were determined. Capillary thickening was classified into four categories. RESULTS: Diabetic group showed more than 75% stenosis in 57% (vs. 56% in nondiabetic) of the anterior tibial; 78% (vs. 68%) of the posterior tibial; 58% (vs. 50%) of the peroneal leg arteries. Diabetic and nondiabetic patients have predominance of type VI atherosclerotic lesions. The comparison of both groups showed no significant differences in atherosclerotic lesions. Diabetic patients had significantly more PAS positive capillary thickening (63% vs. 23%). CONCLUSIONS: There were no differences in histological characteristics of atherosclerosis between the two groups. Capillary thickening has been more observed in diabetics.