Progression of Lower-Extremity Arterial Occlusive Disease in Type II Diabetes Mellitus

Lee

et al. 2014

J Orthopaed Traumatol

BackgroundAlthough vascular disease is commonly accepted as a risk factor for wound complications and prosthetic joint infections, little is known about the preoperative prevalence of lower-extremity peripheral vascular disease in patients undergoing total knee arthroplasty (TKA). In this study, we investigated the prevalence of asymptomatic vascular disease and its risk factors.Materials and methodsA total of 1,000 knees of 692 patients who underwent primary TKA due to osteoarthritis were preoperatively evaluated by experienced musculoskeletal radiologists using Doppler ultrasonography of the lower extremity vessels. The mean age of the patients was 74.1 years (range 65–81). Risk factors for development of peripheral vascular disease were investigated.ResultsAbnormal findings were identified in 38 knees of 32 patients (4.6 %); atherosclerotic changes in 31 knees of 25 patients (3.6 %), deep vein thrombosis (DVT) in two knees, and anomalous vessels in five knees. Three out of 31 knees with atherosclerotic changes showed severe luminal stenosis. Two knees were moderate and 26 knees showed mild changes according to our institutional criteria. Multivariate logistic regression analysis showed that age and diabetes mellitus were positively associated with vascular pathology.ConclusionThe prevalence of incidentally detected peripheral vascular disease was significant. Three of 31 knees had severe arterial stenosis and two knees had DVT. All patients with vascular pathologies had one or more risk factors related to vascular disease. Out of those patients, age was the most important risk factor. Understanding the prevalence of vascular pathology and related risk factors in TKA candidates may be important for successful TKA.Level of Evidence Level III.

Section: Discussionmentioning

confidence: 69%

Asymptomatic peripheral vascular disease in total knee arthroplasty: preoperative prevalence and risk factors

Lee

et al. 2014

J Orthopaed Traumatol

“…In a German population aged ≥65 years, subjects with diabetes had a higher prevalence of PAD in comparison with that of non-diabetics (26.3% vs. 15.3%) [16]. In a U.S. population aged 50 to 70 years, the prevalence of PAD in diabetic patients was 22.0% [17]. PAD was found in 21.1% of newly diagnosed type 2 diabetic Italian patients aged >30 years [18].…”

Section: Discussionmentioning

confidence: 99%

The Prevalence of Peripheral Arterial Disease in Korean Patients with Type 2 Diabetes Mellitus Attending a University Hospital

Hwang

Shin

et al. 2011

Diabetes Metab J

BackgroundPeripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis and is associated with significant morbidity and mortality. Diabetes is known to increase the risk of PAD two- to four-fold. The prevalence of PAD in Korean diabetic patients has not been established. In this study, we investigated the prevalence of PAD in Korean patients with type 2 diabetes attending a large university hospital and analyzed the factors associated with PAD.MethodsA total of 2,002 patients with type 2 diabetes who underwent ankle-brachial index (ABI) measurement in an outpatient clinic were enrolled. PAD was defined as an ABI ≤0.9. Clinical characteristics of 64 patients with PAD were compared with those of 192 age- and sex-matched control patients without PAD.ResultsOf the 2,002 type 2 diabetic patients, 64 (3.2%) were diagnosed as having PAD. PAD was associated with higher prevalences of retinopathy, nephropathy, neuropathy, cerebrovascular and coronary artery disease. Patients with PAD had higher systolic blood pressure and serum triglyceride level and reported higher pack-years of smoking. Multivariate analysis showed that the presence of micro- and macrovascular complications and high systolic blood pressure are factors independently associated with PAD.ConclusionThe prevalence of PAD in diabetic patients was 3.2%, suggesting that the prevalence in Korean diabetic patients is lower than that of patients in Western countries.

Experimental Biology and Medicine

“…However, other factors must also be considered: (i) elevated Hbalc levels could compromise O2 unloading (3, 37); (ii) poorly controlled diabetics exhibit decreased red blood cell deformability and increased blood viscosity (29,37); (iii) lower capillary/muscle fiber ratios could affect diffusion of 0 2 (38,39); and/or (iv) finally, there could be a decrease in slow twitch muscle fibers or the loss of their oxidative potential (40).…”

Section: Discussionmentioning

confidence: 99%

Oxygen Transport and Peripheral Microcirculation in Long-Term Diabetes

Young

Pendergast

Steinbach

1991

The purpose of this investigation was to evaluate the impact of long-term diabetes on muscle blood flow (MBF) and oxygen transport (vO2) during exercise. Twelve male patients (58 +/- 8 years, mean +/- SD), with at least a 10-year history of diabetes controlled by insulin, and seven age-matched controls (56 +/- 5 years, mean +/- SD) participated in this study. No patient had been clinically diagnosed as having peripheral vascular disease, and on the average resting ankle/arm systolic blood pressure ratios were normal. Following a baseline period, 5 min of cycle ergometer exercises at 75 W were performed in the upright position and, after 1-hr recovery, in the supine position. Continuous vO2 was determined via breath-by-breath analysis. MBF was measured in the vastus lateralis (VL) and tibialis anterior (TA) by 133Xe clearance. In the erect position, the diabetic group (compared with the control group, respectively) exhibited significantly (P less than 0.05) lower exercise MBF [ml. (100 g.min)-1] in both VL (19 +/- 2.5 vs 30.9 +/- 2) and TA (13.7 +/- 2 vs 22.0 +/- 4), a lower steady-state VO2 (1.3 +/- 0.3 vs 1.7 +/- 0.2 liters.min-1) during exercise including the values in the last 15 sec of exercise, and greater accumulation of blood lactate (35 +/- 2 vs 22.0 +/- 2 mg/100 ml). The same trends in the data were observed during supine exercise; however, the blood pressure of the diabetics was significantly elevated during exercise when compared with that of controls. The reduced exercise MBF in the TA and VL demonstrated that impaired microvascular flow, without clinically overt peripheral vascular disease, in long-term diabetics leads to reduced oxygen delivery and exercise tolerance.