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The influence of diabetes and lower limb arterial disease on cutaneous foot perfusion.
J Vasc Surg 2006; 44(4):770-5JV

Abstract

OBJECTIVE

Peripheral arterial occlusive disease and peripheral neuropathy are major risk factors in diabetic foot disease. We evaluated the relative influences of noncritical lower limb arterial disease and peripheral neuropathy on cutaneous foot perfusion in diabetes.

METHOD

Toe-brachial pressure indices, transcutaneous oxygen, and carbon dioxide tensions at foot and chest sites were measured in individuals with diabetes, with or without detectable peripheral neuropathy and with or without significant arterial disease on color duplex imaging. Subjects without diabetes, with and without arterial disease, were used as controls.

RESULTS

A total of 130 limbs were studied during an 8-month period. Toe-brachial pressure indices reflected the presence of arterial disease in all groups. Foot transcutaneous oxygen values were reduced in diabetes and correlated with chest transcutaneous oxygen values. Low foot transcutaneous oxygen with elevated transcutaneous carbon dioxide values were only demonstrated in individuals with diabetes, arterial disease, and peripheral neuropathy. Toe-brachial pressure indices demonstrated a positive correlation with foot transcutaneous oxygen values, but values >1.2 demonstrated a negative correlation.

CONCLUSIONS

We demonstrated two influences on cutaneous foot perfusion in diabetes: (1) a global microcirculatory dysfunction, reflected in low chest and foot transcutaneous oxygen values, and (2) macrovascular disease as indicated by reduced toe-brachial pressure indices and foot transcutaneous oxygen values. Further, the results demonstrated that in diabetic individuals without critical limb ischemia, impaired foot perfusion secondary to arterial disease is amplified significantly by coexisting microcirculatory disease.

Authors+Show Affiliations

Wound Healing Research Unit, Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom. dwill1964@aol.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16930928

Citation

Williams, Dean T., et al. "The Influence of Diabetes and Lower Limb Arterial Disease On Cutaneous Foot Perfusion." Journal of Vascular Surgery, vol. 44, no. 4, 2006, pp. 770-5.
Williams DT, Price P, Harding KG. The influence of diabetes and lower limb arterial disease on cutaneous foot perfusion. J Vasc Surg. 2006;44(4):770-5.
Williams, D. T., Price, P., & Harding, K. G. (2006). The influence of diabetes and lower limb arterial disease on cutaneous foot perfusion. Journal of Vascular Surgery, 44(4), pp. 770-5.
Williams DT, Price P, Harding KG. The Influence of Diabetes and Lower Limb Arterial Disease On Cutaneous Foot Perfusion. J Vasc Surg. 2006;44(4):770-5. PubMed PMID: 16930928.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The influence of diabetes and lower limb arterial disease on cutaneous foot perfusion. AU - Williams,Dean T, AU - Price,Patricia, AU - Harding,Keith G, Y1 - 2006/08/23/ PY - 2005/04/27/received PY - 2005/06/30/accepted PY - 2006/8/26/pubmed PY - 2006/10/27/medline PY - 2006/8/26/entrez SP - 770 EP - 5 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 44 IS - 4 N2 - OBJECTIVE: Peripheral arterial occlusive disease and peripheral neuropathy are major risk factors in diabetic foot disease. We evaluated the relative influences of noncritical lower limb arterial disease and peripheral neuropathy on cutaneous foot perfusion in diabetes. METHOD: Toe-brachial pressure indices, transcutaneous oxygen, and carbon dioxide tensions at foot and chest sites were measured in individuals with diabetes, with or without detectable peripheral neuropathy and with or without significant arterial disease on color duplex imaging. Subjects without diabetes, with and without arterial disease, were used as controls. RESULTS: A total of 130 limbs were studied during an 8-month period. Toe-brachial pressure indices reflected the presence of arterial disease in all groups. Foot transcutaneous oxygen values were reduced in diabetes and correlated with chest transcutaneous oxygen values. Low foot transcutaneous oxygen with elevated transcutaneous carbon dioxide values were only demonstrated in individuals with diabetes, arterial disease, and peripheral neuropathy. Toe-brachial pressure indices demonstrated a positive correlation with foot transcutaneous oxygen values, but values >1.2 demonstrated a negative correlation. CONCLUSIONS: We demonstrated two influences on cutaneous foot perfusion in diabetes: (1) a global microcirculatory dysfunction, reflected in low chest and foot transcutaneous oxygen values, and (2) macrovascular disease as indicated by reduced toe-brachial pressure indices and foot transcutaneous oxygen values. Further, the results demonstrated that in diabetic individuals without critical limb ischemia, impaired foot perfusion secondary to arterial disease is amplified significantly by coexisting microcirculatory disease. SN - 0741-5214 UR - https://www.unboundmedicine.com/medline/citation/16930928/The_influence_of_diabetes_and_lower_limb_arterial_disease_on_cutaneous_foot_perfusion_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(06)01023-8 DB - PRIME DP - Unbound Medicine ER -