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Rivista di Angiologia
Official Journal of the , the International Union of Phlebology and the
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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International Angiology 1998 Dicembre;17(4):282-6
Atherosclerosis in amputated legs of patients with and without diabetes mellitus
Mozes G., Keresztury G. *, Kadar A., Magyar J. **, Sipos B., Dzsinich S. *, Gloviczki P. ***
From the 2nd Department of Pathology and *Department of Cardiovascular Surgery Semmelweis University of Medicine, ** National Institute of Rehabilitation, Budapest, Hungary and *** Division of Vascular Surgery, Mayo Clinic, Rochester, Minnesota USA
Background. The aim of this study was to compare the histomorphologic appearance of atherosclerosis in amputated legs of diabetic and non-diabetic patients.
Methods. Twenty-eight legs amputated below the knee for chronic ischaemia were studied. Fourteen legs were amputated in patients with diabetes (10 Type II, 4 non- classified) and 14 in non-diabetics. The mean age of patients at the time of the amputation was 63.3 years in diabetics and 63.9 years in non-diabetics. Samples were taken from the main arteries at the following levels: the midleg, 5 cm above the ankle, 3 cm below the ankle and 10 cm below the ankle. Cross-sections of the arteries were examined with light microscopy and the severity of the occlusive disease determined using morphometric analysis. Medial calcification and chronic inflammation were assessed semiquantitatively.
Results. Arteries at 5 cm above the ankle were more se-verely stenotic in diabetics than in non-diabetics (p<0.05). In both diabetics and non-diabetics the posterior tibial and plantar arteries appeared to be the most stenotic. Medial calcification tended to be more prominent in diabetics than in non-diabetics. Chronic inflammation in the arterial wall occurred at the same degree in diabetics and non-diabetics. In non-diabetics chronic inflammation was more severe in the posterior tibial and plantar arteries than in the anterior tibial and dorsalis pedis arteries (p<0.04). Chronic arterial inflammation correlated with the severity of chronic arterial occlusive disease (p<0.0002).
Conclusions. In diabetics occlusive disease in amputated legs is more severe in arteries above the ankle than in non-diabetics. However, no difference was demonstrated in this series in arteries of the ankle and foot. Diabetics are likely to have more medial calcification in the arteries than non-diabetics. Chronic inflammation in the arterial wall is associated with more severe stenosis.