Features Analysis of Lower Extremity Arterial Lesions in 162 Diabetes Patients

Objective. This study aimed to investigate the angiographic manifestations of lower extremity atherosclerotic steno-occlusive disease in patients with diabetes.Materials and Methods. A total of 162 patients with diabetes were enrolled in this study. The angiographic findings of lower extremity arterial lesions were evaluated according to location (iliac, femoral, popliteal, and crural artery), type (stenosis or occlusion), and length (<5 cm, 5–10 cm, and >5 cm).Results. A total of 131 of 162 (80.9%) diabetics showed multiple segmental lesions, and 19.1% (31/162) presented single segmental lesions in the lower extremity artery. Crural artery was the mainly involved location (39/162, 85.8%). Among the recorded 660 lesions of 162 cases, 437 (66.2%) were occlusion lesions, while 223 (33.8%) were stenosis lesions. Of 437 occlusion lesions, 308 lesions (70.5%) were in crural artery. More than 10 cm occlusion lesion (242/392, 61.7%) was the main manifestation in crural artery, especially in anterior (92/127, 67.2%) and posterior tibial arteries (91/124, 73.4%), which was higher than that in iliac artery (8/33, 24.2%), popliteal artery (53/157, 33.8%), and femoral artery (11/78, 14.1%).Conclusion. In diabetic subjects with lower limb artery ischemia, the vascular involvement is extremely diffuse and particularly severe in crural arteries, with high prevalence of more than 10 cm occlusion lesions.

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The Infrapopliteal Arterial Occlusions Similar to Buerger Disease: Report of Two Cases

Case Reports in Vascular Medicine ◽

10.1155/2014/874528 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Kimihiro Igari ◽

Toshifumi Kudo ◽

Takahiro Toyofuku ◽

Yoshinori Inoue ◽

Takehisa Iwai

Keyword(s):

Fibromuscular Dysplasia ◽

Smoking Habit ◽

Posterior Tibial Artery ◽

Pathological Findings ◽

Posterior Tibial ◽

Tibial Arteries ◽

Disease Case ◽

Popliteal Artery Entrapment ◽

The Right ◽

Crural Arteries

We herein present two cases that required the differential diagnosis of Buerger disease. Case 1 involved a 55-year-old male with a smoking habit who was admitted with ulcers and coldness in his fingers and toes. Angiography showed blockage in both the radial and posterior tibial arteries, which led to an initial diagnosis of Buerger disease. However, a biopsy of the right posterior tibial artery showed pathological findings of fibromuscular dysplasia (FMD). Case 2 involved a 28-year-old male with intermittent claudication who was examined at another hospital. Angiography showed occlusion of both popliteal and crural arteries, and the patient was suspected to have Buerger disease. However, computed tomography disclosed an abnormal slip on both sides of the popliteal fossa, and we diagnosed him with bilateral popliteal artery entrapment syndrome (PAES). These cases illustrate that other occlusive diseases, such as FMD and PAES, may sometimes be misdiagnosed as Buerger disease.

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Relationship Between Caregiver Attendance at Wound Clinic Visits and Wound Healing in Patients With Diabetes: A Retrospective Multicenter Evaluation

Wound Management & Prevention ◽

10.25270/wmp.2021.12.1624 ◽

2021 ◽

Vol 67 (12) ◽

pp. 16-24

Author(s):

Carol Jessee

Keyword(s):

North Carolina ◽

Wound Healing ◽

Standard Deviation ◽

Lower Extremity ◽

Lower Limb ◽

Healing Rate ◽

Lower Number ◽

Descriptive Statistics ◽

Patients With Diabetes ◽

Clinic Visits

BACKGROUND: Lower extremity wounds in patients with diabetes are significant and burdensome. PURPOSE: To evaluate retrospectively the correlation between lower limb wound outcomes in patients with diabetes and the presence of a caregiver during clinic visits. METHODS: The study was conducted in 3 outpatient wound centers in North Carolina. Patients (N = 85) were categorized into 2 groups: those who were accompanied by a caregiver at 50% or more of their visits to the wound clinic (n = 30) and those accompanied by a caregiver at fewer than 50% of their visits (n = 55). Data were evaluated using descriptive statistics and 2 sample t-tests. RESULTS: Although significant findings between the 2 groups were seen in age, race, Visit Count, Weeks in Service, Accompanied Count, and percentage of visits accompanied, the strongest meaningful correlation was in the Accompanied group between Percent Accompanied and Visit Count. In this group, the number of accompanied visits was 7.47 (range [standard deviation], 1–23 [5.2]) and the percentage was 87% (range [standard deviation], 52–100 [15]). This was stastically significant and with a moderately negative correlation (P = .04; r = -0.38). CONCLUSION: Despite negative predictors of healing, those who were accompanied by a caregiver at 50% or more of their visits demonstrated a higher healing rate and a lower number of total visits than those who were accompanied by a caregiver at fewer than 50% of their visits.

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High prevalence of lower extremity peripheral artery disease in type 2 diabetes patients with diabetic nephropathy and the role of netrin-1 levels

Endocrine Abstracts ◽

10.1530/endoabs.49.gp96 ◽

2017 ◽

Author(s):

Ahmet Kor ◽

Suleyman Baldane ◽

Suleyman Hilmi Ipekci ◽

Kamile Marakoglu ◽

Ali Altinok ◽

...

Keyword(s):

Type 2 Diabetes ◽

Diabetic Nephropathy ◽

Lower Extremity ◽

Peripheral Artery Disease ◽

Peripheral Artery ◽

High Prevalence ◽

Artery Disease ◽

Diabetes Patients

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STUDY ON THE CHARACTERISTICS OF DOPPLER ULTRASOUND OF LOWER EXTREMITY ARTERIES IN PATIENTS WITH DIABETES MELLITUS TYPE 2

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2011.5.4 ◽

2011 ◽

pp. 25-30

Author(s):

Keyword(s):

Diabetes Mellitus ◽

Doppler Ultrasound ◽

Lower Extremities ◽

Arterial Stenosis ◽

Invasive Technique ◽

Atherosclerotic Plaques ◽

Type 2 Dm ◽

Arterial Lesions ◽

Patients With Diabetes

Objectives: Vascular Doppler ultrasound is a non-invasive technique to rapidly detect lesions of the vessels in the lower extremities with high accuracy. The use of this technique for detecting early vascular damages in patients with diabetes mellitus (DM) type 2 could help preventing major vascular complications caused by this disease. Materials and Method: This descriptive, cross-sectional study included 31 patients with type 2 DM who were treated in Endocrinology - Neurology - Respiratory Department, Hue Central Hospital between March and August 2011. All patients were undergone clinical and biochemical examinations, and Doppler ultrasound for detection of arterial lesions in their lower extremities. Results: Most patients had high intima media thickness (IMT) (77.42%), and all of them suffered from hypertension concomitant, with the rate of atherosclerotic plaque accounted for 35.48%. No one experienced arterial stenosis >50% and arterial occlusions, but the peak systolic velocities were significantly higher in patients with atherosclerotic plaques than those without atherosclerotic plaques. Conclusion: Vascular Doppler ultrasound should be used as routine test for early detection of arterial lesions in patients with type 2 DM.

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Letter - Hyperbaric oxygen therapy in the treatment of ischemic lower extremity ulcers in patients with diabetes: Results of the DAMO2CLES multicenter randomized clinical trial. Commentary on article in Diabetes Care

Undersea and Hyperbaric Medicine ◽

10.22462/01.02.2018.18 ◽

2018 ◽

Vol 45 (1) ◽

pp. 114-115

Author(s):

Richard Clarke ◽

◽

James R. Hussey ◽

Keyword(s):

Clinical Trial ◽

Lower Extremity ◽

Randomized Clinical Trial ◽

Hyperbaric Oxygen ◽

Diabetes Care ◽

Hyperbaric Oxygen Therapy ◽

Oxygen Therapy ◽

Patients With Diabetes

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Association of infrapopliteal medial arterial calcification with lower-limb amputations in high-risk patients: A systematic review and meta-analysis

Vascular Medicine ◽

10.1177/1358863x20979738 ◽

2020 ◽

pp. 1358863X2097973

Author(s):

Fabrizio Losurdo ◽

Roberto Ferraresi ◽

Alessandro Ucci ◽

Anna Zanetti ◽

Giacomo Clerici ◽

...

Keyword(s):

Risk Factor ◽

High Risk ◽

Lower Limb ◽

Fixed Effects ◽

Meta Analysis ◽

Arterial Calcification ◽

High Risk Patients ◽

Patients With Diabetes ◽

Risk Patients ◽

Medial Arterial Calcification

Medial arterial calcification (MAC) is a known risk factor for cardiovascular morbidity. The association between vascular calcifications and poor outcome in several vascular districts suggest that infrapopliteal MAC could be a risk factor for lower-limb amputation (LLA). This study’s objective is to review the available literature focusing on the association between infrapopliteal MAC and LLA in high-risk patients. The PubMed and Embase databases were systematically searched. We selected original studies reporting the association between infrapopliteal MAC and LLAs in patients with diabetes and/or peripheral artery disease (PAD). Estimates were pooled using either a fixed-effects or a random-effects model meta-analysis. Heterogeneity was evaluated using the Q and I2 statistics. Publication bias was investigated with a funnel plot and Egger test. The trim-and-fill method was designed to estimate the possibly missing studies. Influence analysis was conducted to search studies influencing the final result. Test of moderators was used to compare estimates in good versus non-good-quality studies. Fifteen articles satisfied the selection criteria ( n = 6489; median follow-up: 36 months). MAC was significantly associated with LLAs (pooled adjusted risk ratio (RR): 2.27; 95% CI: 1.89–2.74; I2 = 25.3%, Q-test: p = 0.17). This association was kept in the subgroup of patients with diabetes (RR: 2.37; 95% CI: 1.76–3.20) and patients with PAD (RR: 2.48; 95% CI: 1.72–3.58). The association was maintained if considering as outcome only major amputations (RR: 2.11; 95% CI: 1.46–3.06). Our results show that infrapopliteal MAC is associated with LLAs, thus suggesting MAC as a possible new marker of the at-risk limb.

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Lower extremity reamputation in people with diabetes: a systematic review and meta-analysis

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2021-002325 ◽

2021 ◽

Vol 9 (1) ◽

pp. e002325

Author(s):

Rongqi Liu ◽

Brian J Petersen ◽

Gary M Rothenberg ◽

David G Armstrong

Keyword(s):

Lower Extremity ◽

Temporal Trend ◽

Meta Analysis ◽

Kendall Test ◽

Incidence Rates ◽

Contralateral Limb ◽

Free Survival ◽

Patients With Diabetes ◽

Parametric Survival ◽

Qualitative Characteristics

In this study, we determined the reamputation-free survival to both limbs and to the contralateral limb only following an index amputation of any-level and assessed whether reamputation rates have changed over time. We completed a systematic search using PubMed and screened a total of 205 articles for data on reamputation rates. We reported qualitative characteristics of 56 studies that included data on reamputation rates and completed a meta-analysis on 22 of the studies which enrolled exclusively participants with diabetes. The random-effects meta-analysis fit a parametric survival distribution to the data for reamputations to both limbs and to the contralateral limb only. We assessed whether there was a temporal trend in the reamputation rate using the Mann-Kendall test. Incidence rates were high for reamputation to both limbs and to the contralateral limb only. At 1 year, the reamputation rate for all contralateral and ipsilateral reamputations was found to be 19% (IQR=5.1%–31.6%), and at 5 years, it was found to be 37.1% (IQR=27.0%–47.2%). The contralateral reamputation rate at 5 years was found to be 20.5% (IQR=13.3%–27.2%). We found no evidence of a trend in the reamputation rates over more than two decades of literature analyzed. The incidence of lower extremity reamputation is high among patients with diabetes who have undergone initial amputations secondary to diabetes, and rates of reamputation have not changed over at least two decades.

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