Diabetic microangiopathy in the patients, suffering diabetes mellitus and chronic critical ischemia of lower extremity
Objective. To investigate quantitative characteristics of the vessels affection in hemomicrocirculatory bed (HMCB) of the skin in patients, suffering diabetes mellitus (DM) and chronic critical ischemia of the lower extremity (HCILE), and to reveal a possibility of their application in clinical practice.
Маterials and methods. There were done 414 micropreparations for immunohistochemical and histological investigation of 165 paraffin blocks, consisting of the skin, subcutaneous cellular tissue and muscles material, obtained in 49 patients with DM and HCILE. The patients were 56 - 88 yrs old, average age have constituted (67.9 ± 8.1) yrs. There were 28 (57.1%) men, and 21 (42.9%) women. The patients were treated in the Vascular Surgery Centre of Clinical hospital «Feofania» of the State administration management in 2013 - 2016 yrs. The skin and muscle probes were taken in 20 patients, who did not owe systemic diseases (control group), for comparative studies. The part of preparations (62.1%) were dyed by hematoxilin and eosin, picrofuxin in accordance to van Gizon procedure. Іmmunohistochemical reactions (37.9% of the preparations) were conducted in accordance to standard protocols, using monoclonal mouse and rabbit’s antibodies.
Results. Characteristic changes of morphometric indices of the cutaneous HMCB in patients, suffering DM and HCILE, were registered. The procedure of calculation was elaborated of the degree index (DI) for diabetic microangiopathy (DMAP). Correlation between the DMAP degree and possibility of thrombosis occurrence after the hybrid arterial reconstruction was revealed.
Conclusion. Internal diameter of cutaneous vessels in the patients, suffering the third degree DMAP, have reduced significantly: for аrteriolas - at average in 2.6 times; venulas - in 3.1 times, and capillaries - by 43%. During the observation period on background of antithrombocytic therapy in patients with DMAP of the first degree the cases of thrombosis of the arterial reconstruction zone were not registered, and in DMAP of the second degree the arterial reconstruction zone thrombosis was registered in 1 (9.1%) of 11 patients, while in DMAP of the third degree - in 7 (22.6%) of 31 patients. Exposure of changes in HMCB of the skin, using clinico-morphological investigation, in patients with DM and HCILE permits to formulate the treatment tactics. The results obtained witness a significant role of DMAP in creation of peripheral vascular resistance and necessity to take into account a DI of DMAP while prescribing examination and conduction of treatment after arterial reconstruction in patients with DM and HCILE.
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