Macrovascular and microvascular disease in diabetic foot disease

Lowry, Danielle Lylie (2019). Macrovascular and microvascular disease in diabetic foot disease. University of Birmingham. M.D.

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Abstract

The objective was to examine how diabetes mellitus (DM) impacts the arterial system of the lower limbs by assessing both macrovascular disease and the microvascular function.

A retrospective cohort study assessed the distribution of disease on digital subtraction angiography in 306 patients, half with DM. The Bollinger score was applied to all infra-inguinal vessels seen. There was a trend towards patients with DM having a higher burden of disease throughout the infra-inguinal arterial tree. When divided by indication for procedure patients without DM had more disease in the pedal vessels.

Secondly, in a prospective study, 24 patients with active foot ulceration were recruited and grouped as having no significant arterial disease (n=14) and those requiring percutaneous angioplasty (PCA, n=10). Laser Doppler fluxmetry (LDF) assessed the microcirculation at regular intervals until healing. Using LDF, the time to maximum flux significantly reduced following PCA, in those that healed (210.5s (72.18-231) to 50.71s (27.38-105.18) p=0.046).

The microcirculation is suggested to improve following PCA; further research is required to explore how changes in the macrocirculation relate to the microcirculation particularly in patients with DM.

Type of Work:

Thesis (Doctorates > M.D.)

Award Type:

Doctorates > M.D.

Supervisor(s):