Search

Background Vascular dysfunction dominates the clinical picture of peripheral autonomic neuropathy in lower extremity. Patients and Methods We have studied functional changes of leg vasculature in 30 patients with chronic ulceration due to peripheral autonomic neuropathy between clinical stages 1 and 3. They suffered from lower extremity wounds. After sympathetic skin response test, pedal arterial blood flow analysis including peak systolic velocity (PSV) and pulsatility index (PI) was made by duplex ultrasonography (DUS) in involved legs. Vascular anatomy of leg was also examined by magnetic resonance angiography. Results The mean PSV value was found 58.32 cm/s in stage 1, 35.31 cm/s in stage 2, and 15.71 cm/s in stage 3. The mean PI value was observed 1.17 in stage 1, 1.43 in stage 2, and 1.87 in stage 3. In chronic stage 3, three patients had inadequate arterial blood supply and recurrent ulcer. Conclusions We suggest that reduced sympathetic activity due to small fiber neuropathy causes temporal variations in leg blood flow. There was a nonlinear relationship between vascular functional changes and stages of disease with increased, intermediate, and decreased blood flow, respectively. DUS assessment of pedal arteries contributed to differentiation of clinical stages and permitted vascular evaluation in the course of peripheral autonomic neuropathy.

Daflon 500 mg has been shown to have beneficial effects on microcirculatory disturbances causing tissue hypoxia in chronic venous insufficiency (CVI). To assess the effects of Daflon 500 mg on venous disorder in the lower extremity by means of dorsal pedal venous oximetry measurements, a 4-week prospective study was carried out in 33 patients having a mild or moderate stage of CVI in one leg. In treatment with Daflon 500 mg at a daily dose of two tablets, there were significant (p>0.05) increases in partial pressure of oxygen (Po2), oxygen saturation (So2) and pH, and a decrease in partial carbon dioxide pressure (Pco2). Clinical findings attributable to CVI were markedly improved. Comparison of dorsal pedal venous, oximetry parameters in the symptomatic leg and the clinically unaffected other leg was made before and after 4 weeks of oral therapy. Significant (p>0.05) differences were observed between involved and healthy lower limbs.

Dorsal pedal venous blood gas analysis was performed in 24 patients with arterial occlusive disease requiring revascularizations of the lower extremities. After the reconstructive surgical procedure, measurements were repeated. It has been observed that this method is useful before surgery since it proves the severity of tissue hypoxia due to perfusion impairment of the foot. Postoperative measurements have detected the effectiveness of the vascular restorations. The results of the trial showed a mean increase in partial pressure of venous blood oxygen (Pvo2) and pH of 30.3% and 13.7% (p0.05) change in response to arterial reconstructions. Symptoms decreased markedly in direct proportion to the increase in dorsal pedal venous Po2 induced by changes in blood flow. This method can be reliably used for assessing the treatment to ensure adequate oxygen delivery to the foot as a result of improved pedal perfusion.

We report 94 arterial injuries in 91 children treated at the Department of Thoracic and Cardiovascular Surgery, Medical School of Dicle University, between 1978 and 1988. The average age was 10.3 (range, 3 to 14) years. Stab wounds were seen in 37 patients (40%). Gunshot wounds were seen in 21 patients (23%), and two cases were caused by iatrogenesis. Vein damage was present in 39 patients (44.4%), and nerve loss was observed in 20 patients (21.2%). Twenty-one cases (23.3%) were associated with fractures. Diagnosis of arterial injury was made by clinical findings. Arteriography was used in 15 patients (16.5%) as the diagnostic method. The surgical interventions performed for arterial repair in our series were end-to-end anastomosis in 61 (64.5%), interposition of autogenous reversed saphenous vein grafts in 22 (23.4%), lateral suture in 8 (8.3%), and ligation in 3 (3.9%) patients. Four patients (5.3%) underwent limb amputation.