| BackgroundSince 1980s, along with the improving of our nation's life standard and increasing ratio of elders, the incidence rate of diabetes is increasing rapidly. According to the data of the Chinese Public Health Department, by 2006 the number has reached to 3%. The complication also increase exponentially, 80% of diabetic patients will die because of the subsequent vasale disease. The artery disease of low limb is one of the four most common subsequent vasale disease. At the time of been diagnosed to have diabetes, about 8% patients have already had diabetic low limb artery disease[1]. The feature of the low limb artery disease of diabetes is as following: the low limb artery have universality and penetrated severe stenosis, and always involved the below knee artery. The diabetic low limb artery disease usually is symmetrical in the distal in both legs, and the terminal low limb deformity rate of was 38%It is very important to understand the part, range and degree of low limb artery disease of diabetes, and to treat properly. Nowadays, there are many different examination methods to diagnose low limb artery disease of diabetes, such as Digital Subtraction Angiography (DSA), color Doppler ultrasound and the ABI degree. We can accurately diagnose the part, range and degree of low limb artery disease through DSA examination.The color Doppler ultrasound and the ABI degree examination will give less accurate results, but they are more costless and little damage to vas. At present, there are very little research about non-invasive detections of lower limb artery disease.There are many different treatments for low limb vascular disease. With the property of little damage, safty and efficiency, Percutaneous Transluminal Angioplasty is commonly used in the diabetic vasal rebuild treatment[2]. But there are different views about Percutaneous Transluminal Angioplasty for low limb artery disease in diabetes, and there are not much research about long term curative effect.Objective(1) To contract of non-invasive detections ( including painful degree, skin temperature detection, ABI degree and color Doppler ultrasound ) in lower limb arterial disease of diabetic patients with DSA, and explore the diagnostic value of them.(2) To explore the angiographic characteristic of lower extremities of patients with diabetic foot.(3) To investigate the effect of Percutaneous Transluminal Angioplasty on diabetic patients with below-knee artery disease in half year. Method(1) Non-invasive detections ( including painful degree, skin temperature detection, ABI degree and color Doppler ultrasound ) were performed in 52 cases suspected of diabetic lower extremity arterial disease (38 patients). The examination range in DSA is from femoral to below knee's artery. All results of non-invasive detections were compared with that of DSA, and evaluate the accordance rate, sensitivity and specificity.(2) The angiographic results of 47 lower extremities of 33 diabetic patients, the characteristics of respective clinical stages and the stenosis degree at femoral, superficial femoral, popliteal and medio arteries were undergone statistical analysis.(3) With Percutaneous Transluminal Angioplasty on 38 lower extremities of 31 diabetic patients, the change of low-limb pains, foot temperature, ankle-brachial index (ABI) and ultrasound evaluation were investigated and analyzed for before and 1 week, 1 month and 6 month after treatment.Results(1) There was no significant difference statistically between non-invasive detections and DSA in the diagnosis of diabetic lower limb arterial disease, except the painful degree (P<0.05). Compared with DSA, the accordance rate, sensitivity, specificity, of the painful degree were 30.77%, 95%, 0%. The accordance rate, sensitivity, specificity of skin temperature detection were 40.38%, 65%, 58.3%. The accordance rate, sensitivity, specificity of ABI were 44.23%, 85%, 58.33%. The accordance rate, sensitivity, specificity of the foot blood speed in color Doppler ultrasound were 61.54%, 92.5%, 66.7%.(2) There were many low limb vascular disease in 47 limbs which we studied. The stenosis degree of anterior tibial arteries and the posterior tibial arteries is heaviest, then are peroneal arteries and superficial femoral. The popliteal and femoral always have little vascular damage. There are 14 patients to have DSA for both legs, and the number of the same stenosis degree in the homo-artery is 35 pairs(42%). There was significant difference in stenosis degree between the above-knee and the below-knee section, but the majority of the below-knee arteries were severely stenosed or were complete occlusion.(3) 63.16% was triple vessel disease. The majority of below-knee arteries were severely stenosed. The efficient rate in 1 week, 1 month and 6 month after interventional therapy were 89.47%, 89.47%, 75.67%. ABI and the foot temperature were both higher after therapy. Under keeping the same size of the inner diameter in femoral, superficial femoral, popliteal and medio arteries after therapy , the ultrasound evaluation of low-limb arteries showed that the blood flow speed in these arteries was increased significantly (P<0.05).But all above indicators were partly regressed in 6 month ,compared with 1 week and 1month after Percutaneous Transluminal Angioplasty. The low-limb survival rate of 6 month was 100%.Conclusion(1) Non-invasive detections were important methods in diagnosis lower limb arterial disease of diabetic patients. The skin temperature detection was comparatively influenced by many subjective and objective factors. The combination of ABI and the foot blood speed in color Doppler ultrasound could decrease missed diagnosis rate. The painful degree is not according to the stenosis degree of low limb vascular.(2)The angiographic characteristic of low limb artery is universality, more vasal involved and symmetry. The steosis degree of below knees artery is always heavier. (3) The treatment of Percutaneous Transluminal Angioplasty on diabetic patients with below-knee arterial disease was effective. The blood serving, degree of ABI, foot temperature, intermitten claudication and rest pain were all mending well. The low-limb deformity rate was 0%. |
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