We have quantitatively assessed the percentage of lower limb arterio-venous (a-v) shunting using a radioisotopic technique and correlated it with autonomic neuropathy evaluated by cardiovascular tests. We have studied three groups of diabetic patients: Group A, 12 non-neuropathic subjects without foot lesions; Group B, 12 neuropathic subjects without foot lesions; Group C, 12 neuropathic subjects with recurrent foot ulcers. Shunting was higher in Group C (10.4 +/- 2.7%) than in Group B (6.8 +/- 2.3%, P < 0.01) and Group A (3.8 +/- 1.2%, P < 0.001). Shunts in Group B were higher than in Group A (P < 0.05). All the tests exploring autonomic function were more impaired in Groups B and C than in Group A, with no difference between Groups B and C. A direct correlation was found between a-v shunting and the following cardiovascular tests: postural hypotension (PH) (r = 0.41, P < 0.02), sustained handgrip (SH) (r = 0.56, P < 0.001), deep breathing (DB) (r = 0.40, P < 0.005) and lying to standing (LS) (r = 0.44, P < 0.01). A positive correlation was also found between a-v shunts and duration of the disease (r = 0.62, P < 0.001). Arterio-venous shunting was found to be directly related to autonomic neuropathy even if the higher shunting found in the patients with foot ulcers was not related to a higher degree of autonomic involvement; in addition, this group of patients was characterized by having a more advanced sensory and motor neuropathy. In conclusion, autonomic neuropathy, through its influence on a-v shunts, may play a role in the pathogenesis of diabetic foot, but peripheral neuropathy probably plays a key role in conditioning the development of the overt clinical manifestations of diabetic foot.
Uccioli, L., Mancini, L., Giordano, A., Solini, A., Magnani, P., Manto, A., et al. (1992). Lower limb arterio-venous shunts, autonomic neuropathy and diabetic foot. DIABETES RESEARCH AND CLINICAL PRACTICE, 16(2), 123-130 [10.1016/0168-8227(92)90083-4].
Lower limb arterio-venous shunts, autonomic neuropathy and diabetic foot
UCCIOLI, LUIGI;
1992-01-01
Abstract
We have quantitatively assessed the percentage of lower limb arterio-venous (a-v) shunting using a radioisotopic technique and correlated it with autonomic neuropathy evaluated by cardiovascular tests. We have studied three groups of diabetic patients: Group A, 12 non-neuropathic subjects without foot lesions; Group B, 12 neuropathic subjects without foot lesions; Group C, 12 neuropathic subjects with recurrent foot ulcers. Shunting was higher in Group C (10.4 +/- 2.7%) than in Group B (6.8 +/- 2.3%, P < 0.01) and Group A (3.8 +/- 1.2%, P < 0.001). Shunts in Group B were higher than in Group A (P < 0.05). All the tests exploring autonomic function were more impaired in Groups B and C than in Group A, with no difference between Groups B and C. A direct correlation was found between a-v shunting and the following cardiovascular tests: postural hypotension (PH) (r = 0.41, P < 0.02), sustained handgrip (SH) (r = 0.56, P < 0.001), deep breathing (DB) (r = 0.40, P < 0.005) and lying to standing (LS) (r = 0.44, P < 0.01). A positive correlation was also found between a-v shunts and duration of the disease (r = 0.62, P < 0.001). Arterio-venous shunting was found to be directly related to autonomic neuropathy even if the higher shunting found in the patients with foot ulcers was not related to a higher degree of autonomic involvement; in addition, this group of patients was characterized by having a more advanced sensory and motor neuropathy. In conclusion, autonomic neuropathy, through its influence on a-v shunts, may play a role in the pathogenesis of diabetic foot, but peripheral neuropathy probably plays a key role in conditioning the development of the overt clinical manifestations of diabetic foot.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.