This journal is
indexed in Scopus
Year 2013 Vol. 21 No 4
GENERAL AND SPECIAL SURGERY
A.A. SHLYAKOVA, K.G. KORNEVA, M.N. KUDYKIN, L.G. STRONGIN
PECULIARITIES OF CHRONIC VENOUS INSUFFICIENCY COURSE IN PATIENTS WITH DIABETES MELLITUS TYPE 2
SBEE HPE "Nizhny Novgorod State Medical Academy"
The Russian Federation
Objectives. To determine the peculiarities of course of the lower limbs chronic venous insufficiency (CVI) in patients with type 2 diabetes mellitus (DM).
Methods. 45 patients with CVI of the lower limbs have been examined, 19 patients with type 2 DM compose the main group, and 26 patients without type 2 DM – the control group. The leading clinical syndrome of CVI (edema, leg pain, varicose and trophic changes) has been assessed according to the 10-point visual analog scale (VAS). Presence and intensity of the diabetic polyneuropathy (DPN) was evaluated with the following scales: “Neuropathic Dysfunctional Account” (NDA), “Neuropathic Symptomatic Score” (NSS). All patients underwent ultrasound triplex scanning (USTS) of the veins and arteries of the lower extremities.
Results. In patients with type 2 DM the severe degree of CVI was revealed. In assessing diabetic polyneuropathy (DPN) reliable differences according to the NDA and NSS scales have been detected that testify to the presence of DPN in the patients with type 2DM. The leading clinical signs in patients with type 2 DM was edematous changes (52,6%), pain syndrome – in the control group (50%). In evaluation with a visual analog scale (VAS) the edematous syndrome (5,1±1,5) and trophic changes (4,8±3,6) prevailed in the main group. In USTS of the lower limb vessels in the patients with type 2 DM inconsistency of the saphenofemoral junction and perforating veins of various locations as well as the signs of atherosclerosis of the lower limbs were found. Positive correlation between the duration of type 2 DM and the severity of CVI in patients with macroangiopathy of lower limbs has been revealed.
Conclusions. Type 2 diabetes mellitus was found out to aggravate the course of chronic venous insufficiency of the lower extremities. Clinical and ultrasound features of the CVI course in patients with type 2 diabetes have been determined.
- Kirienko AI, Bogdanets LI, Zolotukhin IA. Mozhno li predotvratit' razvitie troficheskoi iazvy pri varikoznoi bolezni? [Is it possible to prevent the development of trophic ulcers in varicose veins?]. Sprav Poliklin Vracha. 2007;(3):75–78.
- Savel'ev VS, red, Gologorskii VA, Kirienko AI. Flebologiia [Phlebology]: ruk. dlia vrachei. Moscow, RF: Meditsina; 2001. 664 p.
- Sapelkin SV. Oslozhnennye formy khronicheskoi venoznoi nedostatochnosti: sovremennye tendentsii profilaktiki i lecheniia [Complicated forms of chronic venous insufficiency: current trends of prevention and treatment]. SONSILIUM Medicum. 2007;9(7):98–101.
- Savel'ev VS, Pokrovskii AV, Kirienko AI, Bogachev VIu, Bogdanets LI, Sapelkin SV, Gavrilov SG, Zolotukhin IA, Timina IE, Golovanova OV, Zhuraveleva OV, Kuznetsov AN. Sistemnaia terapiia venoznykh troficheskikh iazv. Rezul'taty primeneniia mikronizirovannogo diosmina (Detraleks) [Systemic treatment of venous trophic ulcers. The results of micronized diosmin application (Detralex)]. Angiologiia i Sosudistaia Khirurgiia. 2002;(4):47–52.
- Frykberg RG, Armstrong DG, Giurini J, Edwards A, Kravette M, Kravitz S, Ross C, Stavosky J, Stuck R, Vanore J. Diabetic foot disorders: a clinical practice guideline. American College of Foot and Ankle Surgeons. J Foot Ankle Surg. 2000;39(5 Suppl):S1–60.
- Florea I, Loredana ES, Tolea I. Chronic Venous Insufficiency – Clinical-Evolutional Aspects. Current Health Sci J. 2011;37(1):21–25.
- Stuard S, Cesarone MR, Belcaro G, Dugall M, Ledda A, Cacchio M, Ricci A, Ippolito E, Di Renzo A, Grossi MG. Five-year treatment of chronic venous insufficiency with O-(?-hydroxyethyl)-rutosides: safety aspects. Int J Angiol. 2008 Fall;17(3):143–48.
- Eklof B. Revision of the CEAP classification. Medicographia. 2006;28(2):175–80.
- Eklof B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki P, Kistner RL, Meissner MH, Moneta GL, Myers K, Padberg FT, Perrin M, Ruckley CV, Smith PC, Wakefield TW. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg. 2004 Dec;40(6):1248–52.
- Young MJ, Boulton AJ, MacLeod AF, Williams DR, Sonksen PH. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. 1993 Feb;36(2):150–54.
- Ziegler D, Hanefeld M, Ruhnau KJ, Hasche H, Lobisch M, Schutte K, Kerum G, Malessa R. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a 7-month multicenter randomized controlled trial (ALADIN III Study). ALADIN III Study Group. Alpha-Lipoic Acid in Diabetic Neuropathy. Diabetes Care. 1999 Aug;22(8):1296–01.
- Ziegler D, Ametov A, Barinov A, Dyck PJ, Gurieva I, Low PA, Munzel U, Yakhno N, Raz I, Novosadova M, Maus J, Samigullin R. Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care. 2006 Nov;29(11):2365–70.
603005, Rossiiskaia Federatsiia, g. Nizhnii Novgorod, pl. Minina i Pozharskogo, d. 10/1, GBOU VPO «Nizhegorodskaia gosudarstvennaia meditsinskaia akademiia», kafedra endokrinologii i vnutrennikh boleznei,
Shliakova Anna Andreevna
Shlyakova A.A. A post-graduate student of endocrinology and internal diseases chair of SBEE HPE “Nizhny Novgorod State Medical Academy”.
Korneva K.G. PhD, associate professor of endocrinology and internal diseases chair of SBEE HPE “Nizhny Novgorod State Medical Academy”.
Kudykin M.N. MD, professor of the extreme surgery chair of SBEE HPE “Nizhny Novgorod State Medical Academy”.
Strongin L.G. MD, professor, a head of endocrinology and internal diseases chair of SBEE HPE “Nizhny Novgorod State Medical Academy”.