Year 2014 Vol. 22 No 6

GENERAL AND SPECIAL SURGERY

G.A. SMIRNOV, V.V. PETROVA, T. GVAZAVA, A.V. REMEZOV, V.P. AKIMOV

THE ROLE OF THE VENOUS SYSTEM LESION IN PATHOGENESIS OF DIABETIC FOOT SYNDROME

SBEE HPE North-West State Medical University named after I.I. Mechnikov, Saint-Petersburg,
The Russian Federation

Objectives. To study the feature changes of the lower limbs veins in the diabetic foot syndrome.
Methods. The results of the macro- and microscopic investigations of the lower limb veins have been analyzed. The preparations obtained after the lower limb amputation or at the autopsy of 70 patients have been studied. The preparations were subdivided into 3 groups: 30 preparations were of the patients with the pyo-necrotic complications of diabetic foot syndrome (DFS), 20 preparations of chronic venous diseases patients (CVD), 20 without any lower limb venous pathology. Macroscopic research with venous state estimation has been carried out. Microscopic investigation on micropreparations obtained from macropreparations has been conducted. Immunohistochemical study with the assessment of collagen type IV deposition in the venous wall has been performed.
Results. The results in macroscopic research of the preparations of the lower limb vein have shown the reliable difference between samples of different groups by a number of parameters, such as paravasal tissue edema, vein wall thickness, presence of areas of veins expansion diameter, paravasal fibrosis and phlebotrombosis. Microscopic research has demonstrated high frequency of intramural and paravasal fibrosis, musculas layer disorganization, endothelial mis-proliferation and phlebotrombosis in the lower limb veins of patients with DFS. There was no incidence of chronic vein wall inflammation and venous valve destruction. During immunohistochemical studies in 19 out of 20 cases the collagen type IV hyperproduction in the subendothelial space has been found out in the lower limb venous preparations in case of DFS.
Conclusion. Changes of the venous system in diabetic foot syndrome differ from those in chronic venous insufficiency and manifest by primary lesions of deep veins, marked fibrosis, tendency towards phlebothrombosis without valve affection as well as chronic inflammations of the venous wall.

Keywords: diabetes mellitus, diabetic foot syndrome, chronic venous disease, venous insufficiency
p. 693-700 of the original issue
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Address for correspondence:
191015, Rossiyskaya Federatsiya,
g. Sankt-Peterburg, ul. Kirochnaya,
d. 41, GBOU VPO Severo-Zapadnyiy
gosudarstvennyiy meditsinskiy universitet
im. I.I.Mechnikova,
kafedra khirurgii im. N.D. Monastyirskogo,
tel. mob. 7-911-919-01-82,
e-mail: akimov.spbmapo@ mail.ru,
Akimov Vladimir Pavlovich
Information about the authors:
Smirnov G.A. A post-graduate student of the surgery chair named after N.D.Monastyrsky of SBEE HPE North-West State Medical University named after I.I. Mechnikov.
Petrova V.V. PhD, associate professor of the surgery chair named after N.D.Monastyrsky of SBEE HPE North-West State Medical University named after I.I. Mechnikov.
Gvazava T. A post-graduate student of the surgery chair named after N.D.Monastyrsky of SBEE HPE North-West State Medical University named after I.I. Mechnikov.
Remezov A.V. A post-graduate student of the surgery chair named after N.D.Monastyrsky of SBEE HPE North-West State Medical University named after I.I. Mechnikov.
Akimov V.P. MD, professor, a head of the surgery chair named after N.D.Monastyrsky of SBEE HPE North-West State Medical University named after I.I. Mechnikov.
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