Impact of Diabetes and Peripheral Arterial Occlusive Disease on the Functional Microcirculation at the Plantar Foot

Kabbani, Mohammad; Rotter, Robert; Busche, Marc N.; Wuerfel, Waldemar; Jokuszies, Andreas; Knobloch, Karsten; Vogt, Peter M.; Kraemer, Robert

doi:10.1097/gox.0b013e3182a4b9cb

Cited by 19 publications

(24 citation statements)

References 53 publications

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“…Increased peripheral vascular resistance, inadequate blood supply, and capillary rarefaction often manifest in the microcirculation in diabetic people (Nyberg et al, 2015). Hyperglycemia may lead to decreased deformability, increased aggregation of red blood cells and increased plasma viscosity, which could impair vascular responses (Chao and Cheing, 2009; Kabbani et al, 2013). Moreover, the thickened microvascular intima caused by hyperglycemia would hinder the diffusion of NO from endothelial cells to smooth muscle and reduce the responsiveness of vascular smooth muscle, which may strongly affect the increase of blood flow during vibration (Maloney-Hinds et al, 2009; Ichioka et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

Effects of Local Vibration With Different Intermittent Durations on Skin Blood Flow Responses in Diabetic People

Ren

Luan

et al. 2019

Front. Bioeng. Biotechnol.

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Objective: Poor blood flow supply is an important pathological factor that leads to the development and deterioration of diabetic foot ulcers. This study aims to investigate the acute effects of local vibration with varying intermittent durations on the plantar skin blood flow (SBF) response in diabetic and healthy subjects.Methods: Eleven diabetic patients (7 males, 4 females) and 15 healthy adults (6 males, 9 females) participated in this experiment and accepted three tests. Local continuous vibration (LCV) and two levels of local intermittent vibration (LIV1 and LIV2) were randomly applied to the middle metatarsal head of each subject's right foot in each test. The SBF was measured prior to intervention (Baseline), during Vibration and during the Recovery Stage for each test. The mean SBF in each stage, the change percentages and change rates of SBF in Vibration and Recovery stage among three tests were compared and analyzed for both diabetic and healthy subjects.Results: For diabetic subjects, the SBF was significantly increased in both Vibration and Recovery Stage with local intermittent vibrations (LIV1 and LIV2), but not with LCV. However, there was no significant difference in change percentage and change rate of SBF in diabetic subjects across the three tests. For healthy subjects, all vibration interventions significantly increased the SBF in the Vibration Stage and in the first 1.5 min of the Recovery Stage. Also, the change rate of SBF during the Vibration stage in LIV1 test was significantly greater than that in LIV2 test for healthy subjects. Moreover, change percentage of SBF in Vibration stage of LIV1 test and in some periods of Recovery stages of LIV1 and LIV2 tests for diabetic subjects were lower than for healthy subjects; the absolute change rate of SBF in LIV1 test for diabetic subjects was also lower than for healthy subjects.Conclusion: These findings suggest that both LIV1 and LIV2 may effectively improve SBF in the feet of diabetic people, but LCV may not achieve the same level of vasodilatation. The diabetic subjects were also found to have a lower SBF response to applied vibration than the healthy subjects.

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Section: Discussionmentioning

confidence: 99%

Effects of Local Vibration With Different Intermittent Durations on Skin Blood Flow Responses in Diabetic People

Ren

Luan

et al. 2019

Front. Bioeng. Biotechnol.

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“…Common risk factors for arterial occlusive disease such as age, diabetes mellitus, smoking, and dyslipidemia are all associated with decreased tissue perfusion, [23][24][25][26] and the association between microcirculatory dysfunction and occlusive arterial disease has been shown previously. [13][14][15] Since proper microcirculation is a prerequisite for decent wound healing, 27 one might assume that the nature of arterial occlusive disease is the underlying cause of the higher rate of SSIs.…”

Section: Discussion Outcomesmentioning

confidence: 99%

“…12 This study evaluates the incidence and nature of SSI following open aortoiliac surgery for either aneurysmal or occlusive arterial disease. Since occlusive arterial disease is related to microcirculatory dysfunction, [13][14][15] it might have a negative impact on wound healing and therefore the development of SSI. We hypothesize that, due to the different nature of aneurysmal and occlusive disease, patients who undergo aortoiliac surgery for occlusive disease have higher rates of SSI.…”

Section: Introductionmentioning

confidence: 99%

Do Surgical Site Infections in Open Aortoiliac Surgery Differ Between Occlusive and Aneurysmal Arterial Disease?

Langenberg

Roijers

Kluytmans

et al. 2020

Vasc Endovascular Surg

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Background: Surgical site infections (SSI) are frequently seen after aortoiliac vascular surgery (2%-14%). Deep SSIs are associated with graft infection, sepsis, and mortality. This study evaluates the difference in incidence and nature of SSI following open aortoiliac surgery for aneurysmal disease compared to occlusive arterial disease. Methods: A retrospective cohort study was conducted, including all consecutive patients who underwent open aortoiliac vascular surgery between January 2005 and December 2016 in the Amphia Hospital, Breda, the Netherlands. Patients were grouped by disease type, either aneurysmal or occlusive arterial disease. Data were gathered, including patient characteristics, potential risk factors, and development of SSI. Surgical site infections were defined in accordance with the criteria of the Centers for Disease Control. Results: Between January 2005 and December 2016, a total of 756 patients underwent open aortoiliac surgery of which 517 had aortoiliac aneurysms and 225 had aortoiliac occlusive disease. The group with occlusive disease was younger, predominantly male, and had more smokers. After exclusion of 228 patients undergoing acute surgery, the SSI rate after elective surgery was 6.2%, with 10 of 301 SSIs in the aneurysmal group (3.0%) and 22 of 213 SSIs in the group with occlusive disease (10.3%, P < .001). Also, infection-related readmission and reintervention were higher after occlusive surgery, 6.6% versus 0.9% ( P < .001) and 4.2% versus 0.9% ( P = .003), respectively. Staphylococcus aureus was found as the most common pathogen, causing 64% of SSI in occlusive disease versus 10% in aneurysmal disease ( P = .005). Logistic regression showed occlusive arterial disease and chronic renal disease were associated with SSI. Conclusion: Our study presents evidence for a higher rate of SSI in patients with aortoiliac occlusive disease compared to aortoiliac aneurysmal disease, in part due to inherent use of inguinal incision in patients with occlusive disease. All precautions to prevent SSI should be taken in patients undergoing vascular surgery for arterial occlusive disease.

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“…8 La hipótesis del "síndrome de robo capilar", muestra que la reducción de la SpO2 en sangre capilar juega un papel esencial en la clasificación y severidad de úlceras del pie y en la cicatrización de heridas, por tanto, menor saturación de oxígeno se asocia a una mayor severidad del pie diabético. 9,10 En presencia de neuropatía, hipoperfusión o isquemia, un trauma menor provoca una ulceración cutánea, alteración en la cicatrización, infección y finalmente amputación. 11 La clasificación de Meggit-Wagner estadifica la severidad del pie diabético e identifica el pie en riesgo.…”

Section: Discussionunclassified

Baja saturación de oxígeno como factor de riesgo para desarrollar pie diabético

López¹,

García²,

López³

et al. 2019

Atención Familiar

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Objetivo: evaluar la saturación de oxígeno en extremidades pélvicas de acuerdo con la presencia de pie diabético en pacientes con diabetes mellitus tipo 2 (dm2). Métodos: estudio transversal analítico. Se incluyeron pacientes con dm2 de más de cinco años de evolución, de 20 a 80 años de edad que acudieron a la Unidad de Medicina Familiar (umf) no. 28, en la Ciudad de México. Para estadificar la severidad del pie diabético se utilizó la clasificación de Meggit-Wagner, se consideró la presencia de pie diabético en pacientes de grados 1 a 3. Mediante oximetría de pulso se determinó el valor de saturación de oxígeno (SpO2) en extremidades pélvicas. Se evaluaron otras variables como atrofia y resequedad en la piel, antecedente de hipertensión arterial, índice de masa corporal (imc) y descontrol glucémico. Se realizó prueba de χ2 para diferencia de proporcionesy U de Mann-Whitney para diferencia de medianas. Para conocer los factores de riesgo asociados a pie diabético se realizó un modelo de regresión logística. Resultados: se incluyó un total de 126 pacientes, 23% presentó pie diabético (n=29), de los cuales, 90% presentó Meggit-Wagner grado 1 (n=26) y 10% Wagner grado 3 (n=3). Los pacientes con pie diabético mostraron una mediana de SpO2 90% en comparación con una SpO2 95% en los pacientes sin pie diabético (p<0.001). En el modelo multivariado, la SpO2 <90% mostró un or 10.5 (ic 95% 2.6, 41.6). Las variables de atrofia y resequedad de piel y antecedente de hipertensión arterial también fueron factores de riesgo para desarrollar pie diabético. Conclusión: los pacientes con pie diabético mostraron menor SpO2. Un nivel de saturación menor a 90% es un factor de riesgo independiente de otros factores para el desarrollo de pie diabético.

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Impact of Diabetes and Peripheral Arterial Occlusive Disease on the Functional Microcirculation at the Plantar Foot

Cited by 19 publications

References 53 publications

Effects of Local Vibration With Different Intermittent Durations on Skin Blood Flow Responses in Diabetic People

Effects of Local Vibration With Different Intermittent Durations on Skin Blood Flow Responses in Diabetic People

Do Surgical Site Infections in Open Aortoiliac Surgery Differ Between Occlusive and Aneurysmal Arterial Disease?

Baja saturación de oxígeno como factor de riesgo para desarrollar pie diabético

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