Date of Award

1-1-1984

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Dr. Richard J. Gusberg

Second Advisor

Dr. Jonathan P. Gertler

Abstract

The literature regarding angiographic patterns of arteriosclerosis obliterans (ASO) in the legs of diabetics and nondiabetics is reviewed. The medical records of 28 adult-onset diabetics and 35 nondiabetics with chronic ASO of the lower extremities who underwent angiography for the first time were analyzed for age, presenting symptoms, smoking history, history of hypertension and therapeutic fate of the affected limbs. The arteriograms were analyzed for basic disease patterns and degree of disease at specific segments of the arterial tree, based on the radiologist's findings. Diabetics have more popliteal and trifurcation disease than nondiabetics, but less than has been found in previous studies. Nondiabetics have significantly more aortoiliac disease. The two groups present at the same average age, but with worse clinical symptoms and findings in the diabetic. The diabetic limb is typified by worse symptoms in the presence of better blood flow than the nondiabetic limb, possibly due to decreased resistance to infection and superimposed autonomic /sensory neuropathies. As a result, the diabetic undergoes more major and minor amputations. Because diabetics and nondiabetics have been seen to fare similarly with bypass surgery, it is suggested from this study that diabetic limb salvage might improve if intervention is undertaken earlier in the course of diabetic leg vessel ASO. Larger series are needed to compare and update the comparative arteriographic patterns of lower extremity ASO in diabetics and nondiabetics, and to further define the fate of the diabetic claudicator.

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