Diabetes and peripheral vascular disease

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Presentation transcript:

Diabetes and peripheral vascular disease Cameron M. Akbari, MD, Frank W. LoGerfo, MD Journal of Vascular Surgery Volume 30, Issue 2, Pages 373-384 (August 1999) DOI: 10.1016/S0741-5214(99)70154-0 Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Depiction of role of endothelial nitric oxide (NO) and nitric oxide synthetase (NOS) in vasodilatory response to acetylcholine (endothelium-dependent response). In contrast, sodium nitroprusside, as exogenous nitric oxide donor, directly activates cyclic guanosine monophospate (cGMP) with resultant vasorelaxation. TXA 2 , Thromboxane A2 ; PGs, prostaglandins. Journal of Vascular Surgery 1999 30, 373-384DOI: (10.1016/S0741-5214(99)70154-0) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Underlying mechanisms of diabetic foot ulceration. Sensorimotor neuropathy leads to diminished sensation and small muscle atrophy in foot, resulting in flexed metatarsals, metatarsal head prominence, and clawing of toes. Altered architecture of foot, coupled with ischemia and microvascular dysfunction, ultimately leads to ulceration. Journal of Vascular Surgery 1999 30, 373-384DOI: (10.1016/S0741-5214(99)70154-0) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Since 1984, there has been a significant drop in major amputations at the authors’ institution, concomitant with a rise in distal lower extremity arterial reconstruction. (With permission from LoGerfo FW, Gibbons GW, Pomposelli FB Jr, et al. Trends in the care of the diabetic foot: expanded role of arterial reconstruction. Arch Surg 1992;127:617-21.). Journal of Vascular Surgery 1999 30, 373-384DOI: (10.1016/S0741-5214(99)70154-0) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions