Sage Journals: Discover world-class research

Abstract

AIMS:

To evaluate endothelial-dependent and – independent cutaneous vasodilator responses in the feet of patients with peripheral arterial disease (PAD) with or without Type 2 diabetes.

METHODS:

Cutaneous microvascular responses in the dorsum of both lower limbs were measured in the supine position using Laser Doppler Fluximetry combined with iontophoretic administration of endothelial-dependent (acetylcholine, Ach) and -independent (sodium nitroprusside, SNP) vasodilators in diabetic (n = 19) and non diabetic (n = 17) patients with PAD (presenting as unilateral calf intermittent claudication (IC).

RESULTS:

In patients with diabetes and IC, endothelial-dependent vasodilation was significantly impaired in the symptomatic limb [74 (57,105) vs 68 (24,81) PU, Z =−2.79, p = 0.005] compared to the asymptomatic limb. Patients without diabetes showed no impairment of vasodilation. Resting ankle-brachial pressure index did not identify the presence of abnormalities in microvascular function.

CONCLUSIONS:

The combination of diabetes and PAD is associated with a reduction in endothelial-dependent cutaneous vasodilation in the feet without an associated reduction in endothelial independent vasodilation.

Keywords

Type 2 diabetes peripheral arterial disease microvascular function endothelial dysfunction

Get full access to this article

View all access options for this article.

References

Wild

, Roglic

, Green

, Sicree

and King

, Global prevalence of diabetes: Estimates for the year and projections for –, Diabetes Care 27(5) (2004), 1047–1053.

Department of Health. Turning the corner improving diabetes care. 2006 http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4136141

Fowkes

F.G.

, Housley

, Cawood

E.H.

, Macintyre

C.C.

, Ruckley

C.V.

and Prescott

R.J.

, Edinburgh Artery Study: Prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population, Int J Epidemiol 20(2) (1991), 384–392.

Olin

J.W.

and Sealove

B.A.

, Peripheral artery disease: Current insight into the disease and its diagnosis and management, Mayo Clin Proc 85(7) (2010), 678–692.

Selvin

and Erlinger

T.P.

, Prevalence of and risk factors for peripheral arterial disease in the United States: Results from the National Health and Nutrition Examination Survey, 1999–2000, Circulation 110(6) (2004), 738–743.

Dormandy

, Heeck Ludger

and Vig

, The natural history of claudication: Risk to life and limb, Semin Vasc Surg 12 (1999), 123–37.

Formosa

, Cassar

, Gatt

, Mizzi

, Camileri

K.P.

, Azzopardi

, DeRaffaele

, Falzon

, Cristina

and Chockalingam

, Hidden dangers revealed by misdiagnosed peripheral arterial disease using ABPI measurement, Diabetes Res Clin Pract 102(2) (2013), 112–116.

Hodges

G.J.

, Nawaz

and Tew

G.A.

, Evidence that reduced nitric oxide signal contributes to cutaneous microvascular dysfunction in peripheral arterial disease, Clin Hemorheol Microcirc2014 May 5, Epub ahead of print.

Rossi

, Cupisti

, Perrone

, Mariani

and Santoro

, Acute effect of exercise induced leg ischaemia on cutaneous vasoreactivity in patients with stage II peripheral artery disease, Microvasc Res 64 (2002), 14–20.

10.

Klonizakis

, Yeung

J.M.

, Lingam

, Nash

J.R.

, Manning

and Donnelly

, Effects of posture and venous insufficiency on endothelial- dependent and -independent cutaneous vasodilation in the perimalleolar region, Eur J Vasc Endovasc Surg 26 (2003), 100–104.

11.

Alkhatib

and Klonizakis

, Effects of exercise training and Mediterranean diet on vascular risk reduction in post-menopausal women, Clin Hemorheol Microcirc 57(1) (2014), 33–47.

12.

Shojaiefard

, Khorgami

and Larijani

, Independent risk factors for amputation in diabetic foot, Int J Diabetes Dev Ctries 28(2) (2008), 32–37.

13.

Nerone

V.S.

, Springer

K.D.

, Woodruff

D.M.

and Atway

S.A.

, Reamputation after minor foot amputation in diabetic patients: Risk factors leading to limb loss, J Foot Ankle Surg 52(2) (2013), 184–187.

14.

Dinh

, Scovell

, Veves

, Peripheral arterial disease and diabetes: A clinical update, Int J Low Extrem Wounds 8(2) (2009), 75–81.

15.

Libby

, Ridker

P.M.

and Maseri

, Inflammation and atherosclerosis, Circulation 105 (2002), 1135–1143.

16.

Kluz

, Małecki

and Adamiec

, Practical importance and modern methods of the evaluation of skin microcirculation during chronic lower limb ischemia in patients with peripheral arterial occlusive disease and/or diabetes, Int Angiol 32(1) (2013), 42–51.

17.

Young

M.J.

, Adams

J.E.

, Anderson

G.F.

, Boulton

A.J.

and Cavanagh

P.R.

, Medial arterial calcification in the feet of diabetic patients and matched non-diabetic control subjects, Diabetologia 36 (1993), 615–621.

Effect of diabetes on the cutaneous microcirculation of the feet in patients with intermittent claudication