CLINICO-PATHOLOGICAL ASSESSMENT OF VASCULAR LESIONS IN COMPLICATED DIABETIC FOOT
Journal Title: World Journal of Pharmaceutical and Medical Research - Year 2017, Vol 3, Issue 4
Abstract
Background: The pathological lesions of microcirculation in diabetic foot have not been previously fully studied. Identification of such lesions and their association with clinical findings in complicated diabetic foot will allow the expansion of the knowledge related to the pathological background of this condition. The aim of this study is to perform a quantitative report on microvascular changes of complicated diabetic foot and correlate these changes with clinical findings in such patients. Patients and Methods: This is a prospective study on all cases admitted to the surgical department, King Fahd Hospital of University with diabetic foot problems who required foot amputation between January 2014 and September 2015. Preoperative diagnosis was based on history and comprehensive neuro-vascular physical examination ± Computed angiogram (CTA). Skin and tissue biopsies were taken from the amputated foot and subjected to histopathological and immunohistochemical study. The findings were compared with similar parameters of non-diabetic patients (controls). Results: During the study period, 26 patients (22 diabetic and 4 controls) were included. Of the diabetic patients, 16 (73%) had peripheral arterial disease (PAD). There was significant difference between diabetic and control groups in small blood vessel basement membrane thickness (22.46±10.28 microns in diabetic vs. 10.51±3.15 microns in control, p=<0.001) and microvascular area density (41.61±19.54/mm2 in diabetic vs. 13.27±2.44/mm2 in control p=<0.001). However there was no significant difference in small vessel (microvascular) changes between diabetics with and without PAD. Arteriolar hyalinosis and mononuclear inflammatory cell infiltrate was seen in all diabetic cases. Conclusion: Ischemia of the diabetic foot is secondary to pre-existing diabetic microangiopathy which is often aggravated by superimposed multi-segment arterial disease.
Authors and Affiliations
Mohamed Elsharawy
Keywords
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