CHARACTERIZATION OF BLOOD FLOW IN DIFFERENT FORMS OF DIABETIC FOOT SYNDROME

Yu.I. Pavlov
Chelyabinsk State Medical Academy,
Chelyabinsk, Russia

The lowering of the mean blood flow velocity (Vmean), pulsation index (PI), resistance index (RI) revealed by Doppler ultrasonography is most characteristic of patients with the ischemic form (IF) and mixed form (MF) of diabetic foot syndrome (DFS). The IF is marked by the high degree damping of the pulse wave in limb segments (damping factor). These changes are less significant in the MF of DFS and are in fact lacking in patients with the neuropathic form (NF). In health, the ankle brachial index (ABI) is equal to 1.0. The rise of the index up to 1.1-1.3 is common to patients with the NF of DFS. Occlusion and stenotic lesions of the arteries are associated with the index lowering to 0.7-0.8. The decrease of the index to 0.5 is recorded in critical ischemia. Nevertheless in 10.3% of cases with clinically manifest ischemia, the ABI remains within normal which is determined by arterial wall rigidity in the presence of Menkenberg' s atherosclerosis.Laser Doppler flowmetry provided to patients with the IF of DFS revealed a decrease in the level of the basic and postischemic flow in the feet and legs. The maintenance of the high parameters of the micro-circulatory flow in patients with the NF and MF of DFS is regarded as a consequence of blood shunting in arteriolo-venulat anastomoses.Analysis of thermograms (Thermovision 400, AGEMA) has demonstrated that circulatory deterioration is associated with a decrease in the intensity of infrared irradiation of the legs. Patients with the IF and MF of DFS are characterized by the "amputation" type tomograms This stems from the lowering of the temperature of the distal segments in the presence of ischemia whereas the NF is marked by the "hot feet" symptom.In patients with the IF of DFS, .TcpO2 is 1.3 times lower than in those with the MF and 1.7 times lower in the NF of DFS (p<0.05). In the MF of DFS, the level of oxygenation is 1.3 times lower versus patients with the NF (p<0.05), in which it does not differ from normal.Thus, the hemodynamic parameters in different forms of DFS are significantly different which is especially noticeable in the distal segments of the legs.

KEY WORDS: diabetic foot, blood flow parameters.

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