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International Angiology 1998 December;17(4):282-6


language: English

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.

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