Acta Medica Leopoliensia (Sep 2018)
Determination of the severity of the damage of the emomycocirculatory channel patients with diabetes mellitus with critical ischemia of the lower limb
Abstract
Aim. To determine the quantitative characteristics of lesions of the hemomycrocirculatory channel of the skin and muscles in patients with diabetes mellitus with critical ischemia of the lower limb. And to develop a method for calculating the degree of diabetic microangiopathy. Material and Methods. Samples of paraffin blocks of skin and muscles of 49 patients (experimental group) with diabetes mellitus, type II with chronic critical ischemia of the lower limb, against a background of combined stenotic-occlusive lesions of the arteries of the femoral and pediculophagomic segments, in combination with ulcerative-necrotic foot lesions, who were treated at the Center for Vascular Surgery at the Clinical Hospital "FEOPHANIA" of the State Department of Affairs during 2013 - 2016 were selected. A comparison group included the selected samples of skin and muscles of 20 patients without systemic diseases. Histologic and immunohistochemical studies were conducted to detect collagen IV - the marker of the basal membranes, VEGF - the vascular endothelial germ factor; CD 31 - the endothelial factor; and smooth muscle actin. The diameters of the blood vessels of the hemomicrocirculatory channel of skin of and muscles and the density of the capillaries were measured and compared. On the basis of the obtained data, the calculation of the degree of diabetic microangiopathy was performed. Results and Discussion. Characteristic changes were observed in the morphometric indices of blood vessels in the hemomicrocirculatory channel of the skin and muscles in patients with diabetes mellitus, type II with chronic critical ischemia of the lower limb. The method of calculating the degree of diabetic microangiopathy was developed. The correlation between the degree of diabetic microangiopathy and the probability of thrombosis after hybrid arterial reconstruction was revealed, and the algorithm of patient examination in the postoperative period was developed. Conclusions. The quantitative indicators that vary depending on the course and compensation of diabetes mellitus were identified: the vascular density of the hemomicrocirculatory channel in the papillary layer of the skin; the thickness of basal membranes of the vessels of the hemomicrocirculatory channel; the diameter of the lumen of the vessels of the hemomicrocirculatory bed. The characteristic qualitative changes in tissues are: the smoothing of the basement membrane of the epidermis, its dissolution in separate areas; the increased expression of VEGFR-1; the increase of expression of actin in blood vessels, including in capillaries; the unequal expression of CD31 in blood vessels. The collection of the data on qualitative and quantitative changes in the hemomicrocirculatory channel of the skin and muscles allowed to develop criteria for the calculation of the degree of diabetic microangiopathy. There was a correlation revealed between the severity of diabetic microangiopathy and the probability of thrombosis after the hybrid arterial reconstruction. Determining the severity of diabetic microangiopathy can be used in determining the algorithm of examination with possible implementation of preventive operations prior to the occurrence of thrombosis of the arterial reconstruction area and the nature of conservative treatment after arterial reconstruction in patients with diabetes with chronic critical ischemia of the lower limb.
Keywords
