Diabetic microangiopathy in the patients, suffering diabetes mellitus and chronic critical ischemia of lower extremity


Keywords: diabetes mellitus; hemomicrocirculatory bed; diabetic microangiopathy; іschemia; hybrid arterial reconstruction

Abstract

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.

References

1. Shah B, Rockman CB, GuoY. Diabetes and vascular disease in different arterial territories. Diabet Care. 2014;37(6):1636-42. doi: 10.2337/dc13-2432.

2. Fox CS, Golden SH, Anderson C, Bray GA, Burke LE, de Boer IH, et al. Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a scientific statement from the american heart association and the american diabetes association. Diabet Care. 2015 Sep;38(9):1777-803. doi: 10.2337/dci15-0012.

3. Rubio JA, Aragón-Sánchez J, Jiménez S. Reducing major lower extremity amputations after the introduction of a multidisciplinary team for the diabetic foot. Int J Low Extrem Wounds. 2014;13(1):22-6. doi: 10.1177/1534734614521234.

4. Nehler MR, Duval S, Diao L. Epidemiology of peripheral arterial disease and critical limb ischemia in an insured national population. J Vasc Surg. 2014;60(3):686-95. doi: 10.1016/j.jvs.2014.03.290.

5. Parodi A, Castello M, Corbetta S, Cordera R, Cristaudo A, Cucchia RG. Skin and diabetes: an experts’ opinion from the Italian diabetologists and dermatologists of the DiaDex group. Ital Dermatol Venereol. 2018 Oct;153(5):649-58. doi: 10.23736/S0392-0488.18.06080-7.

6. Petrov SV, Rajhlin NT Rukovodstvo po immunohimicheskoj diagnostike opuholej cheloveka pod redakciej 3 izdanie dopolnennoe i pererabotannoe. Kazan’: Izd-vo «Titul»; 2004; 456 р. [In Russian].

7. Prophet EB, Mills B, Arrington JB, Sobin L. Laboratory methods in histotechnology. institute of pathology. Washington; 1994. 274 p.

8. Avtandilov GG. Meditsinskaya morfometriya. Rukovodstvo. Moskva: Meditsina; 1990. 384 р. [In Russian].

Author Biographies


S. M. Didenko, Clinical Hospital «Feofania», Kyiv

Didenko S.N., PhD, vascular surgeon,

Center of vascular surgery,

Clinical Hospital «Feofaniya».

Address: 21 Zabolotnogo Str., 03143, Kyiv, Ukraina, tel.: +38 (044) 259-65-74

 E-mail: hirurgdidenko@gmail.com

ORCID:0000-0002-3115-7524


O. V. Kalenska, Clinical Hospital «Feofania», Kyiv

Kalenska O.V., PhD,

head of the pathoanatomical department,

Clinical Hospital «Feofaniya».

Address: 21 Zabolotnogo Str., 03143, Kyiv, Ukraina, tel.: +38 (044) 259-67-38

E-mail: ovkalenska@ukr.net

https://orcid.org./0000-0002-5925-3067


L. V. Kalenska, Clinical Hospital «Feofania», Kyiv

Kalenska L.V., pathologist of the pathoanatomical department,

Clinical Hospital «Feofaniya».

Address: 21 Zabolotnogo Str., 03143, Kyiv, Ukraina, tel.: +38 (044) 259-67-38

E-mail: lvkalenska@ukr.net

https://orcid.org./0000-0002-4296-8357


V. U. Subbotin, Clinical Hospital «Feofania», Kyiv

Subbotin V.U., vascular surgeon,

head of the Center of Vascular Surgery,

Clinical Hospital «Feofaniya».

Address: 21 Zabolotnogo Str., 03143, Kyiv, Ukraina, tel.: +38 (044) 259-67-70

E-mail:vitaliksub@ukr.net

https://orcid.org./0000-0002-1538-7004


I. M. Savytska, Shalimov National Institute of Surgery and Transplantology, Kyiv

Savytska I.M., PhD, senior researcher,

Department of Experimental Surgery,

Shalimov’sNacional Institute of Surgeri and Transplantation

30, Geroyev Sevastopolya str., Kyiv, Ukraine, 03680

irinasavitska@ukr.net/ 0975100401

https://orcid.org./0000-00020-2749-7825


Yu. M. Hupalo, Scientific-Practical Centre of Prophylactic and Clinical Medicine, Kyiv

HupaloY.M., PhD,vascular surgeon,

leading researcher at the department of minimally invasive surgery,

Research and Practical Center of Preventive and Clinical Medicine

Address: 5 Verchniay Str., 01014, Kyiv, Ukraina, tel.: +380679367820

ORCID : 0000-0002-4856-1398


O. E. Shved, Scientific-Practical Centre of Prophylactic and Clinical Medicine, Kyiv

Shved O.E., PhD, vascular surgeon,

senior researcher at the department of minimally invasive surgery

Research and Practical Center of Preventive and Clinical Medicine

Address: 5 Verchniay Str., 01014, Kyiv, Ukraina, tel.:+390673216191

E-mail: Lenashved@ukr.net

https://orcid.org./0000-0002-7652-9301


D. Yu. Shapovalov, Scientific-Practical Centre of Prophylactic and Clinical Medicine, Kyiv

Shapovalov D.U., vascular surgeon,

junior researcher at the scientific

department of minimally invasive surgery

Research and Practical Center of Preventive and ClinicalMedicine

Address: 5 Verchniay Str., 01014, Kyiv, Ukraina, tel.:+380679900911

E-mail: pandanila.kiev@gmail.com

https://orcid.org./0000-0001-7419-9559

Published
2018-09-30
How to Cite
Didenko, S. M., Kalenska, O. V., Kalenska, L. V., Subbotin, V. U., Savytska, I. M., Hupalo, Y. M., Shved, O. E., & Shapovalov, D. Y. (2018). Diabetic microangiopathy in the patients, suffering diabetes mellitus and chronic critical ischemia of lower extremity. Klinicheskaia Khirurgiia, 85(9), 31-34. https://doi.org/10.26779/2522-1396.2018.09.31
Section
General Problems of Surgery