title: Dysfunctional vasa vasorum in diabetic peripheral artery obstructive disease with critical lower limb ischaemia.
abstract: OBJECTIVE
  To establish whether in diabetic patients with peripheral artery obstructive disease (PAOD) vasa vasorum (vv) neoangiogenesis is altered with increased arterial damage.
  
  
  METHODS
  Thirty-three patients with PAOD and critical lower limb ischaemia, 22 with type II diabetes.
  
  
  METHODS
  Immunohistochemistry for endothelial cell markers (CD34 and von Willebrand Factor); real-time reverse transcription polymerase chain reaction (RT-PCR) to quantify arterial wall expression of vascular endothelial growth factor (VEGF); enzyme-linked immunosorbent assay (ELISA) to assess blood VEGF; flow cytometry to detect circulating endothelial cells (CECs).
  
  
  RESULTS
  Patients with PAOD and diabetes have a higher frequency (60% vs. 45%) of advanced atherosclerotic lesions and a significant reduction (p = 0.0003) in CD34(+) capillaries in the arterial media. Adventitial neoangiogenesis was increased equally (CD34(+) and vWF(+)) in all patients. Likewise, all patients have increased CEC and VEGF concentration in the blood as well as in-situ VEGF transcript expression.
  
  
  CONCLUSIONS
  Patients with PAOD have remarkable arterial damage despite increased in-situ and circulating expression of the pro-angiogenic VEGF; a dysfunctional vv angiogenesis was seen in diabetics which also showed a higher frequency of parietal damage; it is suggested that in diabetic arterial wall, injury is worsened by vv inability to finalise an effective VEGF-driven arterial wall neoangiogenesis.
authors.affiliation: Department of Specialistic Surgical and Anaestesiological Sciences, S. Orsola-Malpighi Hospital - University of Bologna, Via Massarenti, 9 Bld 5, 40126 Bologna, Italy. catia.orrico2@unibo.it
authors.forename: C
authors.initials: C
authors.lastname: Orrico
authors.forename: G
authors.initials: G
authors.lastname: Pasquinelli
authors.forename: L
authors.initials: L
authors.lastname: Foroni
authors.forename: D
authors.initials: D
authors.lastname: Muscarà
authors.forename: P L
authors.initials: PL
authors.lastname: Tazzari
authors.forename: F
authors.initials: F
authors.lastname: Ricci
authors.forename: M
authors.initials: M
authors.lastname: Buzzi
authors.forename: E
authors.initials: E
authors.lastname: Baldi
authors.forename: N
authors.initials: N
authors.lastname: Muccini
authors.forename: M
authors.initials: M
authors.lastname: Gargiulo
authors.forename: A
authors.initials: A
authors.lastname: Stella
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018952:Antigens, CD34 / Q000032:analysis; D001157:Arterial Occlusive Diseases / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology*; D016022:Case-Control Studies; D016638:Critical Illness; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology*; D042783:Endothelial Cells / Q000473:pathology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007150:Immunohistochemistry; D007511:Ischemia / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology*; D007558:Italy; D035002:Lower Extremity / Q000098:blood supply* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018919:Neovascularization, Physiologic; D012333:RNA, Messenger / Q000032:analysis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014651:Vasa Vasorum / Q000737:chemistry / Q000473:pathology / Q000503:physiopathology*; D042461:Vascular Endothelial Growth Factor A / Q000097:blood / Q000235:genetics; D014841:von Willebrand Factor / Q000032:analysis
chemical_list: D018952:Antigens, CD34; D012333:RNA, Messenger; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D014841:von Willebrand Factor