Vascular disease is the most frequent complication of diabetes, and also the most frequent non-traumatic cause of lower-limb amputation. In an effort to prevent these serious complications, recent years have seen an increased emphasis on routine screening of diabetic patients.
Screening of diabetics with color Doppler ultrasound (CDUS) is an effective method for identifying early-stage vascular lesions, even in asymptomatic patients, according to Italian researchers who presented a study at the March European Congress of Radiology. Greek researchers in another presentation described CDUS as "essential" in initial workups of diabetic patients.
Dr. Matteo Salcuni of the University d'Annunzio in Imbaro, Italy presented the results of a study in which 217 diabetic patients underwent vascular screening with CDUS of the carotid arteries, the abdominal aorta, and the lower limbs, in order to evaluate the presence of vascular lesions.
One hundred thirty-six of the patients were asymptomatic, but had signs of vascular disease such as laterocervical bruit or absence of a peripheral pulse, while 81 patients (37%) presented with symptoms of cerebrovascular insufficiency, and/or ischemic disease of the lower limbs, according to Salcuni.
All of the patients underwent CDUS and the results were confirmed with angiography in all patients with CDUS evidence of advanced stenosis, Salcuni said. In all, CDUS revealed 158 patients (72.8%) with steno-obstructive stenosis of 50% or greater, while 59 patients (27.2%) had no evidence of lesions. Fifteen patients underwent subsequent thromboendarterectomy of the carotid artery, eight had percutaneous transluminal angioplasty of the iliac and superficial femoral arteries, 12 had femoro-distal revascularization, and 10 received drug treatment.
"In our experience, noninvasive vascular screening with (CDUS) is a valid method for identifying vascular lesions in early stages of disease," Salcuni concluded. "Nearly 45% of patients with lesions were asymptomatic."
Another study, presented the same morning by Dr. P. Hadjilira from Athens, Greece, assessed the value of CDUS vascular screening for patients with diabetes mellitus type II who were visiting a diabetes clinic for the first time. The yearlong study screened 40 patients aged 40-70 with CDUS. The procedure revealed stenosis of 50% or greater in 12 patients, medium stenosis of the peripheral arteries in 14, and severe stenoses in 22. Because clinical findings had underestimated the severity of angiopathy in 8 patients, the authors concluded that CDUS is essential in the initial workup of diabetic patients.
By Eric Barnes
AuntMinnie.com staff writer
May 2000
Related Reading
"Impaired glucose tolerance, Type II diabetes mellitus and carotid atherosclerosis: prospective results from the Bruneck Study," Diabetologia 2000 Feb;43(2):156-64
"Atherosclerotic changes of extracoronary arteries are associated with the extent of coronary atherosclerosis," Am J Cardiol 2000 Apr 15;85(8):949-952
"Endothelial vasodilator function is related to low-density lipoprotein particle size and low-density lipoprotein vitamin E content in type 1 diabetes," J Am Coll Cardiol 2000 Feb;35(2):292-9
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