Sympathetic vasomotor response of the radial artery in patients with diabetic foot syndrome.
OBJECTIVE
Neurophysiological assessment of the peripheral autonomic system is characterized by various limitations. An alternative approach to laser Doppler and venous plethymography is the assessment of the sympathetic vasomotor response of the radial artery obtained by continuous wave Doppler sonography. Nomogram data have been established and demonstrate the temporary disappearance of diastolic flow after coughing or deep inspiration.


METHODS
We assessed the sympathetic vasomotor response in 25 patients (mean age 64 years, range 43-76) with diabetic foot syndrome. The Doppler data were correlated with nerve conduction studies of the median and peroneal nerve, the extent of radiologically diagnosed media sclerosis, and compared with nomogram values (n = 41).


RESULTS
Although similar mean flow velocities were found under baseline conditions, the flow pattern was characterized by higher pulsatility in the diabetic group (resistance index [RI] 1.1 vs. 0.7). No significant difference in RI was observed after coughing. The latency of onset of the response was prolonged (2.1 vs. 1.5 s), while the duration of the response did not differ (18 vs. 15 s). Only the nerve conduction velocity of the peroneal nerve correlated inversely with the RI. The extent of radiologically proven calcification tended to correlate with the pulsatility of the baseline signal and the response latencies.


CONCLUSIONS
The data obtained by this study suggest the concurrent existence of reduced vessel elasticity due to media sclerosis and dysfunction of the autonomic vasomotor system.
Eicke
Bernhard M
BM
Department of Neurology, Johannes Gutenberg-University, Mainz, Germany. eicke@neurologie.klinik.uni-mainz.de
Bauer
Julian
J
Mink
Susanne
S
Kuhl
Valerio
V
Hlawatsch
Alexander
A
Küstner
Ernst
E
Victor
Anja
A
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D003371:Cough; D017719:Diabetic Foot / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003971:Diastole; D006801:Humans; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology; D017534:Radial Artery / Q000294:innervation*; D011930:Reaction Time; D012016:Reference Values; D013564:Sympathetic Nervous System / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013599:Systole; D018615:Ultrasonography, Doppler, Color