Changes in Microcirculation Following Percutaneous Angioplasty in Patients with Diabetic Foot Ulcers

Abstract

Background: Diabetic foot disease is a condition with increasing worldwide prevalence. Diabetes mellitus (DM) affects the regulation of vascular tone and response to trauma of the skins microcirculation, increasing the risk of ulceration. How microcirculatory function changes following percutaneous angioplasty (PA) and during ulcer healing is poorly understood. This pilot study aims to examine this. Methods: Patients with DM and active foot ulceration were recruited from diabetic foot clinics into one of two cohorts. Group One (G1) had significant peripheral arterial disease (PAD) requiring PA and group Two (G2) had no significant PAD. At recruitment and prior to the procedure the patients pedal microcirculation was examined using laser Doppler fluxmetry. The main parameter examined was time to maximum flux (TtM) following a three-minute occlusion of the affected limb. These measurements were repeated monthly until the ulcer healed. Results: Nine patients were recruited to G1 and fourteen to G2. Six patients had healed by the end of the study in both groups. In G1, there was a reduction in the TtM following PA. At last visit, on the study toe, TtM had significantly reduced from 210.5s (72.18–231) to 50.71s (27.38–105.18, p=0.046) in those who healed. In G2, on both the study toe and dorsum, there was an increase in TtM (study toe, 13.40s (6.33–73.85) to 64.43 (22.05–114.20), p=0.028). Conclusion: PA appears to be related to significant improvement in microvascular reactivity. The increase in TtM in patients without PAD may be related to a reduction in inflammation following healing. A higher powered study is required.