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Int J Angiol 2019; 28(03): 167-172
DOI: 10.1055/s-0039-1692662
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Temporal Vascular Changes in Leg with Ulcer Due to Autonomic Neuropathy

Behçet K. Ener
1   Department of Thoracic and Vascular Surgery, Ümraniye Training and Research Hospital, Istanbul Health Sciences University, Istanbul, Turkey
,
Handan Uçankale
2   Department of Radiology, Ümraniye Training and Research Hospital, Istanbul Health Sciences University, Istanbul, Turkey
,
Reyhan Sürmeli
3   Department of Neurology, Ümraniye Training and Research Hospital, Istanbul Health Sciences University, Istanbul, Turkey
› Author Affiliations
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Publication History

Publication Date:
12 July 2019 (online)

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Abstract

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.

Keywords

autonomic neuropathy - leg blood flow - venous insufficiency - small fiber neuropathy - duplex ultrasonography - magnetic resonance imaging - lower extremity wounds
 

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