[Reduced pulsatility index and elevated ankle systolic pressure as a risk factor for foot ulceration in diabetic patients with autonomic neuropathy].
The contribution of peripheral autonomic neuropathy to development of foot ulcers in diabetic patients has been emphasized recently. The purpose of this study was to demonstrate the association between the sympathetic denervation of the limb and changes of pulsatility index (PI), to compare the blood flow curve in diabetics with neuropathic foot ulcer and in patients after surgical sympathectomy and to asses the value of PI and ankle systolic pressure in identification of diabetic patients with increased risk of foot ulceration. The changes in blood flow curve and in PI in arteries of upper limb in patients after thoracic sympathectomy (group 1) were recorded. The blood flow curve, PI and ankle systolic pressure were also examined in patients with neuropathic foot ulcer and diabetes (group 2), in patients without foot ulcer and with diabetes (group 3) and in patients without foot ulcers and without diabetes (group 4). The blood flow curve in group 1 was similar to that observed in diabetic patients, especially from group 2. In patients from group 1 the PI was reduced postoperatively. In patients from groups 2, 3 and 4 PI differed significantly with the lowest values in group 2. Ankle systolic pressure also differed in examined groups with the highest values in group 2. We concluded were was sympathetic denervation of the extremity results in lowering of PI and in changes in blood flow curve similar to those observed in neuropathic diabetic foot and that the combined evaluation of PI and ankle systolic pressure could be helpful in identification of diabetic patients with increased risk of neuropathic foot ulceration.
Dzieciuchowicz
L
L
Kliniki Chirurgii Ogólnej, Akademii Medycznej im. K. Marcinkowskiego w Poznaniu.
Rapalski
K
K
Wachal
K
K
D000328:Adult; D000842:Ankle / Q000098:blood supply*; D001794:Blood Pressure / Q000502:physiology*; D017719:Diabetic Foot / Q000175:diagnosis*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D011674:Pulse; D012307:Risk Factors