Diabetologia

, Volume 39, Issue 3, pp 344–348 | Cite as

The impact of reversal of hypoxia by revascularization on the peripheral nerve function of diabetic patients

  • A. Veves
  • V. M. Donaghue
  • M. R. Sarnow
  • J. M. Giurini
  • D. R. Campbell
  • F. W. LoGerfo
Originals
Received:
Revised:

Summary

Hypoxia is considered to be one of the main aetiopathogenic factors of diabetic neuropathy. We have examined the effects of the reversal of hypoxia, achieved by revascularization, on peripheral nerve function in diabetic patients with or without clinical neuropathy. Fifty-six patients [mean age 62 (range 30–74) years, 44 (79%) males, 15 (27%) with insulin-dependent diabetes of 20 years (range 1–57) duration, and creatinine level 92.8±30.9 Μmol/l (mean ± SD)] were tested pre-operatively while 30 (54%) were re-examined at least 6 weeks post-operatively. At baseline the leg scheduled for operation showed worse measurements compared to the control leg when tested for Semmes-Weinstein monofilaments, peroneal motor conduction velocity (PMCV) (33.7±7.18 vs 35.7±6.09 m · s−1, p<0.05) and transcutaneous oxygen tension (37.4±24.6 vs 52.0±21.5 mm Hg, p<0.0001) while no differences were found in the vibration perception threshold and leg temperature. When baseline and post-operative measurements were later compared in the operated leg, no differences were noticed in the vibration perception threshold, PMCV and Semmes-Weinstein monofilaments but the transcutaneous oxygen tension increased significantly (32.7±27.1 vs 64.6±14.5 mm Hg, p<0.001). No differences were noticed in any of the above parameters in the contralateral leg. No correlations were found between changes in transcutaneous oxygen tension and PMCV values measured at baseline and at the follow-up visit in either leg. Similar results were found when patients were stratified according to severity of neuropathy, ischaemia and the level of the bypass. We conclude that although there is greater impairment of nerve function in the more ischaemic leg, reversal of hypoxia does not result in any significant improvement of the nerve function measurements.

Keywords

Hypoxia revascularization peripheral neuropathy 

Abbreviations

NDS

Neuropathy disability score

NSS

neuropathy symptom score

TcPO2

transcutaneous oxygen tension

PNCV

peroneal nerve conduction velocity

VPT

vibration perception threshold

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Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • A. Veves
    • 1
  • V. M. Donaghue
    • 2
  • M. R. Sarnow
    • 2
  • J. M. Giurini
    • 2
  • D. R. Campbell
    • 3
  • F. W. LoGerfo
    • 3
  1. 1.Deaconess-Joslin Foot Center, Department of MedicineHarvard Medical SchoolBostonUSA
  2. 2.Deaconess-Joslin Foot Center, Division of Podiatry, Department of SurgeryHarvard Medical SchoolBostonUSA
  3. 3.Deaconess-Joslin Foot Center, Division of Vascular Surgery, Department of SurgeryHarvard Medical SchoolBostonUSA

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