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The results of evaluation of the soft tissue perfusion of the foot in patients with diabetes and critical lower limb ischemia (CLI) via fluorescence angiography (FAG) in the near-infrared range are represented in the article. The study included 4 diabetic patients with CLI. All patients underwent lower-limb balloon percutaneous transluminal angioplasty. To evaluate the soft tissue perfusion of the foot via FAG the following parameters have been used: T 0m -time to reach maximum for fluorescence intensity after intravenous administration of Indocyanine green; T Im -time of onset of maximum fluorescence intensity after its appearance in the area of interest; I m -the level of the maximum fluorescence intensity. The region of interest was the skin around the wound of the foot. The median FAG parameters in the region of interest on the foot were as follows: prior to surgery T 0m = 164 sec (148-181), T Im = 48 sec (38-56); after surgery: T 0m = 80 sec (69-92); T Im = 27 sec (20-39); (p <0,05). No adverse reactions were registered in the study. Despite the small sample we were able to achieve statistical significance in the difference between the parameters prior to and after surgery. Further prospective studies with extended samples of patients are needed. Keywords: diabetes, peripheral arterial disease, critical limb ischemia, endovascular treatment, near infrared imaging, indocyanine green angiography Contacts: Abdulvapova Z.N., e-mail: zera1987@mail.ru For citations: Abdulvapova Z.N., Grachev P.V., Artemova E.V., Galstyan G.R., Bondarenko O.N., Gorbacheva A.M., Lin`kov K.G., Loschenov V.B. Near infrared imaging for angiography in diabetic patients with peripheral artery disease, Biomedical Photonics, 2017, T. 6, No. 1, pp. 4-11 (in Russian).Оценка состояния кровотока нижних конечностей у пациентов с сахарным диабетом методом флуоресцентной ангиографии в ближнем инфракрасном диапазоне Резюме В работе представлены результаты оценки перфузии мягких тканей стопы у пациентов с сахарным диабетом и критической ишемией нижних конечностей с помощью метода флуоресцентной ангиографии (ФАГ) в ближнем инфракрасном диапазоне. В исследование были включены 4 пациента с сахарным диабетом и критической ишемией нижних конечностей. Всем пациентам была выполнена чрескожная транслюминальная баллонная ангиопластика артерий нижних конечностей. Для оценки перфузии тканей стопы при помощи метода флуоресцентной ангиографии были определены следующие параметры: T 0m -время достижения максимальной интенсивности флуоресценции с момента внутривенного введения индоцианина зеленого; T Im -время наступления максимальной интенсивности флуоресценции с момента ее появления в зоне интереса; I m -уровень максимальной интенсивности флуоресценции. Зоной интереса являлась кожа в околораневой зоне стопы. В результате были получены медианы параметров ФАГ в исследуемой области стопы: до операции -T 0m = 164 с (от 148 до 181), T Im = 48 с (от 38 до 56), и после операции -T 0m = 80 с (от 69 до 92), T Im = 27 с (от 20 до 39) (р<0,05). В ходе исследовани...

Introduction. Critical limb ischemia (CLI) occurs approximately 20 times more frequently among diabetic patients. Frequency of amputations is higher too. Main treatment goal in these situations is in reconstruction of arterial blood flow with bypass surgery or endovascular interventions. Nevertheless, long-term prognosis of survival, limb preservation and life quality among Russian patients that underwent this therapy remains unclear, as well as influencing risk factors.The aim of the study was to evaluate the long-term prognosis in diabetic patients with critical limb ischemia (CLI) after peripheral angioplasty with active and nonactive follow-up period.Methods. 81 diabetic patients with CLI underwent PTA in 88 limbs. Patients were divided into 2 groups: group A (n = 51) – with active follow up (FU) period (visits every 3-6 months during 5 years) and group B (n = 30) - without active FU period (the second visit in our center was performed in 5 years after PTA). Diagnosis and treatment of CLI were based on recommendation of TASC II. The primary outcome was cumulative survival, secondary outcome were cases of repeat PTA and major amputations (MA) after 5 years after surgery.Results. Only 44 (86%) patients from group A finished FU period. There were 37 (46%) men, with mean age 64,1[54-68] years, mean HbA1c 7,9±1,4%, mean duration of diabetes 16,5[0,8-43] years, diabetes type 1/2 - 8/73 (90% of type 2). 82% had arterial hypertension, 5% - strokes, 18,5% - myocardial infarction. Chronical kidney disease of stage 1-2 was detected in 55,5%, stage 3-5 – in 30,8%. Anemia was diagnosed in 67,5%, arrhythmias – in 7,4%. 49,3% of patients suffered from diabetic retinopathy. Patients from both groups were comparable in comorbidities, severity of lower limb artery obstruction’s and degree of tissue damage (p<0,05): peripheral arterial disease (PAD) 4-6 classes according Graziani classification in both groups was in 75(93%) cases; Rutherford classification in both groups: 4 category-12(15%), 5category in 43(53%), and 6 category in 29(31%) patients. Repeat PTA was performed in group A in 15 (35%), in group B in 5(16%) cases. There were major amputations in groups: A-4(9%) vs group B – 4(12%) (log-rank, p<0,05). Cumulative survival in groups: A-80%, in group B-67%. (log-rank, p<0,05).Conclusion. CLI in diabetic patients is accompanied by different complications and is characterized by severe morphological lesions of the lower limbs arteries and soft tissue lesions. Active FU period have advantages in diabetic patients with CLI after PTA: timely done reinterventions with decrease the risk of major amputations and cumulative survival.

Diabetic polyneuropathy is one of the most common late complications of diabetes mellitus, as well as the main cause of ulcerative foot defects. The prevalence of neuropathy among people with diabetes varies from 28 to 65%, depending on the disease duration and diagnostic features. Initial signs of damage are detected as early as in prediabetes. To date, there is a fairly limited knowledge of the mechanisms of nerve fiber damage in diabetes. Also, it is unclear which type of nerve fibers is involved in damage first and how the nervous system regulates repair of tissues and local immunity. Animal models of diabetic peripheral neuropathy enable studying new aspects of the pathogenesis of this common diabetes complication and open prospects for the search and development of new drugs.