Abstract
Aims/hypothesis: We investigated the significance of microangiopathy in the development of foot ulcer, which is still disputed. Methods: We assessed microangiopathy by histological analysis of the capillary ultrastructure using transmission electron microscopy and capillary density and arteriolar morphology in paraffin-embedded sections from the skin of type 2 diabetic patients: 30 neuroischaemic patients (Isc) revascularised with peripheral angioplasty and 30 neuropathic patients (Neu) with foot ulcer, compared with ten non-diabetic volunteers. Results: In the diabetic patients, capillaries in the dermal papillary layer were fewer (−22.2%, 159 ± 43 vs 205 ± 52 mm2 in non-diabetic volunteers, p <0.01). They also showed detrimental remodelling, with a 2.2-fold increase in capillary basement membrane thickness (3.44 ± 1.19 vs 1.53 ± 0.34 μm in non-diabetic volunteers, p <0.001) and a 57.7% decrease in lumen area (14.6 ± 11.1 vs 34.7 ± 27.5 μm2, p <0.001). No differences were observed between the diabetic Isc or Neu patients. Isc were more prone to develop arteriolar occlusion than Neu (16.8 ± 6.9% vs 6.7 ± 3.7%, respectively, p <0.001). No patient had been amputated at 30 days and healing time was significantly longer in Isc (180 ± 120 vs 64 ± 50 days in Neu, p <0.001). Conclusions/interpretation: Capillary microangiopathy is present in equal measure in neuroischaemic and neuropathic diabetic foot skin. The predominance of arteriolar occlusions with neuroischaemia indicated the existence of an additional ‘small vessel disease’ that did not affect an effective revascularisation and did not worsen the prognosis of major amputations but slowed the healing process of the neuroischaemic foot ulcer. Trial registration:: ClinicalTrials.gov NCT02610036.
| Original language | English |
|---|---|
| Pages (from-to) | 1542-1548 |
| Number of pages | 7 |
| Journal | Diabetologia |
| Volume | 59 |
| Issue number | 7 |
| DOIs | |
| Publication status | Published - Jul 1 2016 |
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Keywords
- Amputation
- Arteriolar occlusions
- Basement membrane thickness
- Capillary density
- Diabetic foot
- Neuroischaemic foot
- Neuropathic foot
- Skin biopsy
- Small vessel disease
- Wound healing time
ASJC Scopus subject areas
- Internal Medicine
- Endocrinology, Diabetes and Metabolism
Cite this
Prospective study on microangiopathy in type 2 diabetic foot ulcer. / Fiordaliso, Fabio; Clerici, Giacomo; Maggioni, Serena; Caminiti, Maurizio; Bisighini, Cinzia; Novelli, Deborah; Minnella, Daniela; Corbelli, Alessandro; Morisi, Riccardo; De Iaco, Alberto; Faglia, Ezio.
In: Diabetologia, Vol. 59, No. 7, 01.07.2016, p. 1542-1548.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Prospective study on microangiopathy in type 2 diabetic foot ulcer
AU - Fiordaliso, Fabio
AU - Clerici, Giacomo
AU - Maggioni, Serena
AU - Caminiti, Maurizio
AU - Bisighini, Cinzia
AU - Novelli, Deborah
AU - Minnella, Daniela
AU - Corbelli, Alessandro
AU - Morisi, Riccardo
AU - De Iaco, Alberto
AU - Faglia, Ezio
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Aims/hypothesis: We investigated the significance of microangiopathy in the development of foot ulcer, which is still disputed. Methods: We assessed microangiopathy by histological analysis of the capillary ultrastructure using transmission electron microscopy and capillary density and arteriolar morphology in paraffin-embedded sections from the skin of type 2 diabetic patients: 30 neuroischaemic patients (Isc) revascularised with peripheral angioplasty and 30 neuropathic patients (Neu) with foot ulcer, compared with ten non-diabetic volunteers. Results: In the diabetic patients, capillaries in the dermal papillary layer were fewer (−22.2%, 159 ± 43 vs 205 ± 52 mm2 in non-diabetic volunteers, p <0.01). They also showed detrimental remodelling, with a 2.2-fold increase in capillary basement membrane thickness (3.44 ± 1.19 vs 1.53 ± 0.34 μm in non-diabetic volunteers, p <0.001) and a 57.7% decrease in lumen area (14.6 ± 11.1 vs 34.7 ± 27.5 μm2, p <0.001). No differences were observed between the diabetic Isc or Neu patients. Isc were more prone to develop arteriolar occlusion than Neu (16.8 ± 6.9% vs 6.7 ± 3.7%, respectively, p <0.001). No patient had been amputated at 30 days and healing time was significantly longer in Isc (180 ± 120 vs 64 ± 50 days in Neu, p <0.001). Conclusions/interpretation: Capillary microangiopathy is present in equal measure in neuroischaemic and neuropathic diabetic foot skin. The predominance of arteriolar occlusions with neuroischaemia indicated the existence of an additional ‘small vessel disease’ that did not affect an effective revascularisation and did not worsen the prognosis of major amputations but slowed the healing process of the neuroischaemic foot ulcer. Trial registration:: ClinicalTrials.gov NCT02610036.
AB - Aims/hypothesis: We investigated the significance of microangiopathy in the development of foot ulcer, which is still disputed. Methods: We assessed microangiopathy by histological analysis of the capillary ultrastructure using transmission electron microscopy and capillary density and arteriolar morphology in paraffin-embedded sections from the skin of type 2 diabetic patients: 30 neuroischaemic patients (Isc) revascularised with peripheral angioplasty and 30 neuropathic patients (Neu) with foot ulcer, compared with ten non-diabetic volunteers. Results: In the diabetic patients, capillaries in the dermal papillary layer were fewer (−22.2%, 159 ± 43 vs 205 ± 52 mm2 in non-diabetic volunteers, p <0.01). They also showed detrimental remodelling, with a 2.2-fold increase in capillary basement membrane thickness (3.44 ± 1.19 vs 1.53 ± 0.34 μm in non-diabetic volunteers, p <0.001) and a 57.7% decrease in lumen area (14.6 ± 11.1 vs 34.7 ± 27.5 μm2, p <0.001). No differences were observed between the diabetic Isc or Neu patients. Isc were more prone to develop arteriolar occlusion than Neu (16.8 ± 6.9% vs 6.7 ± 3.7%, respectively, p <0.001). No patient had been amputated at 30 days and healing time was significantly longer in Isc (180 ± 120 vs 64 ± 50 days in Neu, p <0.001). Conclusions/interpretation: Capillary microangiopathy is present in equal measure in neuroischaemic and neuropathic diabetic foot skin. The predominance of arteriolar occlusions with neuroischaemia indicated the existence of an additional ‘small vessel disease’ that did not affect an effective revascularisation and did not worsen the prognosis of major amputations but slowed the healing process of the neuroischaemic foot ulcer. Trial registration:: ClinicalTrials.gov NCT02610036.
KW - Amputation
KW - Arteriolar occlusions
KW - Basement membrane thickness
KW - Capillary density
KW - Diabetic foot
KW - Neuroischaemic foot
KW - Neuropathic foot
KW - Skin biopsy
KW - Small vessel disease
KW - Wound healing time
UR - http://www.scopus.com/inward/record.url?scp=84975270891&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84975270891&partnerID=8YFLogxK
U2 - 10.1007/s00125-016-3961-0
DO - 10.1007/s00125-016-3961-0
M3 - Article
VL - 59
SP - 1542
EP - 1548
JO - Diabetologia
JF - Diabetologia
SN - 0012-186X
IS - 7
ER -