Skip to main content
SpringerLink
Log in

Contrast agent suppresses endothelium-dependent arterial dilation after digital subtraction angiography procedure in patients with diabetic foot

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Recent studies showed that contrast agents can induce renal injury. Thus, the present study was designed to assess whether the contrast agents used during digital subtraction angiography (DSA) procedure can damage endothelium. Fow-mediated endothelium-dependent vasodilation (FMD) was measured at baseline, 1, 3, and 7 days after DSA in 198 subjects with diabetic foot. We also measured the levels of thiobarbituric acid-reactive substances (TBARS) and von Willebrand factor (vWF), interleukin (IL)-6, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP). Compared with baseline (3.60 ± 0.47 %), FMD at 1 day decreased (2.74 ± 0.47 %), and increased significantly from 1 to 3 days (p < 0.01), and returned to baseline level at 7 days after DSA. The plasma TBARS increased at 1 day and decreased from 1 to 3 days (p < 0.01), and returned to baseline level at 7 days after DSA. CRP, IL-6, and TNF-α had similar changes before and after DSA procedure. FMD was significantly correlated to vWF, IL-6, TNF-α, CRP, and TBARS (p < 0.01). A negative correlation between contrast volume and FMD, positive correlation between contrast volume and vWF, TBARS, CRP, IL-6 at 1 or 3 days after DSA exist in diabetic group (p < 0.05). Contrast medium suppresses FMD, probably through an increased production of oxygen-derived free radicals and inflammation although adequate hydration was given in type 2 diabetes. Therefore, an effective prophylaxis should allow to prevent this complication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Jan Apelqvist, Diagnostics and treatment of the diabetic foot. Endocrine 41(3), 384–397 (2012)

    Article  CAS  PubMed  Google Scholar 

  2. P.A. McCullough, Contrast-induced acute kidney injury. JACC 51(15), 1419–1428 (2008)

    Article  PubMed  Google Scholar 

  3. M.T. James, W.A. Ghali, M. Tonelli, P. Faris, M.L. Knudtson, N. Pannu, S.W. Klarenbach, B.J. Manns, B.R. Hemmelgarn, Acute kidney injury following coronary angiography is associated with a long-term decline in kidney function. Kidney Int. 78(8), 803–809 (2010)

    Article  PubMed  Google Scholar 

  4. S.J. Kim, D. Choi, Y.G. Ko, J.S. Kim, S.H. Han, B.K. Kim, S.W. Kang, M.K. Hong, Y. Jang, K.H. Choi, T.H. Yoo, Relation of homocysteinemia to contrast-induced nephropathy in patients undergoing percutaneous coronary intervention. Am. J. Cardiol. 108(8), 1086–1091 (2011)

    Article  CAS  PubMed  Google Scholar 

  5. P.O. Boneti, L.O. Lerman, A. Lerman, Endothelial dysfunction: a marker of atherosclerotic risk. Arterioscler. Thromb. Vasc. Biol. 23(2), 168–175 (2003)

    Article  Google Scholar 

  6. D.G. Armstrong, L.A. Lavery, L.B. Harkless, Validation of a diabetic wound classification system. the contribution of depth, infection, and ischemia to risk of amputation. Diabetes Care 21(5), 855–859 (1998)

    Article  CAS  PubMed  Google Scholar 

  7. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 23(Suppl 1), S4-S19 (2000)

    Google Scholar 

  8. G.D. Xiang, Y.L. Wang, Regular aerobic exercise training improves endothelium-dependent artery dilation in patients with impaired fasting glucose. Diabetes Care 27(3), 801–802 (2004)

    Article  PubMed  Google Scholar 

  9. G.D. Xiang, Y.H. Wu, Apolipoprotein e4 allele and endothelium-dependent arterial dilation in type 2 diabetes mellitus without angiopathy. Diabetologia 46(4), 514–519 (2003)

    Google Scholar 

  10. G.D. Xiang, H.L. Sun, L.S. Zhao, Changes of osteoprotegerin before and after insulin therapy in type 1 diabetic patients. Diabetes Res. Clin. Pract. 76(2), 199–206 (2007)

    Article  CAS  PubMed  Google Scholar 

  11. G.D. Xiang, J.H. Pu, L. Yue, J. Hou, H.L. Sun, α-Lipoic acid can improve endothelial dysfunction in subjects with impaired fasting glucose. Metabolism 60(4), 480–485 (2011)

    Article  CAS  PubMed  Google Scholar 

  12. G.D. Xiang, J.H. Pu, H.L. Sun, L.S. Zhao, Alpha-lipoic acid improves endothelial dysfunction in patients with subclinical hypothyroidism. Exp. Clin. Endocrinol. Diabetes 118(9), 625–629 (2010)

    Article  CAS  Google Scholar 

  13. P.A. McCullough, A. Adam, C.R. Becker, C. Davidson, N. Lameire, F. Stacul, J. Tumlin, CIN consensus working panel, risk prediction of contrast-induced nephropathy. Am. J. Cardiol. 98(6A), 27–36 (2006)

    Article  Google Scholar 

  14. J.Y. Cho, M.H. Jeong, S. Hwan Park, I.S. Kim, K.H. Park, D.S. Sim, N.S. Yoon, H.J. Yoon, H.W. Park, Y.J. Hong, J.H. Kim, Y. Ahn, J.G. Cho, J.C. Park, J.C. Kang, Effect of contrast-induced nephropathy on cardiac outcomes after use of nonionic isosmolar contrast media during coronary procedure. J. Cardiol. 56(3), 300–306 (2010)

    Article  PubMed  Google Scholar 

  15. C. Davidson, F. Stacul, P.A. McCullough, J. Tumlin, A. Adam, N. Lameire, C.R. Becker, CIN consensus working panel, contrast medium use. Am. J. Cardiol. 98(6A), 42–58 (2006)

    Article  Google Scholar 

  16. A. Asif, G. Garces, R.A. Preston, D. Roth, Current trials of interventions to prevent radiocontrast-induced nephropathy. Am. J. Ther. 12(2), 127–132 (2005)

    Article  PubMed  Google Scholar 

  17. G. Marenzi, A.L. Bartorelli, Recent advances in the prevention of radiocontrast-induced nephropathy. Curr. Opin. Crit. Care 10(6), 505–509 (2004)

    PubMed  Google Scholar 

  18. F. Stacul, A. Adam, C.R. Becker, C. Davidson, N. Lameire, P.A. McCullough, J. Tumlin, CIN consensus working panel, strategies to reduce the risk of contrast-induced nephropathy. Am. J. Cardiol. 98(6A), 59–77 (2006)

    Article  Google Scholar 

  19. A.M. Kelly, B. Dwamena, P. Cronin, S.J. Bernstein, R.C. Carlos, Meta-analysis: effectiveness of drugs for preventing contrast-induced nephropathy. Ann. Intern. Med. 148(4), 284–294 (2008)

    Article  PubMed  Google Scholar 

  20. R. Solomon, Contrast-induced acute kidney injury: is there a risk after intravenous contrast? Clin. J. Am. Soc. Nephrol. 3(5), 1274–1281 (2008)

    Article  Google Scholar 

  21. J. Tumlin, F. Stacul, A. Adam, C.R. Becker, C. Davidson, N. Lameire, P.A. McCullough, CIN consensus working panel, pathophysiology of contrast-induced nephropathy. Am. J. Cardiol. 98(6A), 14–20 (2006)

    Article  Google Scholar 

  22. S. Moncada, R.M. Palmer, E.A. Higgs, Nitric oxide: physiology, pathophysiology, and pharmacology. Pharmacol. Rev. 43(2), 109–142 (1991)

    CAS  PubMed  Google Scholar 

  23. R.J. Gryglewski, R.M.J. Palmer, S. Moncada, Superoxide anion is involved in the breakdown of endothelium-dependent vascular relaxing factor. Nature 320(6061), 454–456 (1986)

    Article  CAS  PubMed  Google Scholar 

  24. G.M. Rubanyi, P.M. Vanhoutte, Oxygen-derived free radicals, endothelium, and responsiveness of vascular smooth muscle. Am. J. Physiol. 250(5 Pt 2), H815–H821 (1986)

    CAS  PubMed  Google Scholar 

  25. G.D. Xiang, H.L. Sun, L.S. Zhao, J. Hou, L. Yue, L. Xu, The antioxidant alpha-lipoic acid improves endothelial dysfunction induced by acute hyperglycaemia during OGTT in impaired glucose tolerance. Clin. Endocrinol. (Oxf). 68(5), 716–723 (2008)

    Article  CAS  PubMed  Google Scholar 

  26. S.G. Wannamethee, A.G. Shaper, G.D. Lowe, L. Lennon, A. Rumley, P.H. Whincup, Renal function and cardiovascular mortality in elderly men: the role of inflammatory, procoagulant, and endothelial biomarkers. Eur. Heart J. 27(24), 2975–2981 (2006)

    Article  CAS  PubMed  Google Scholar 

  27. C. Ferri, G. Croce, V. Cofini, G. De Berardinis, D. Grassi, R. Casale, G. Properzi, G. Desideri, C-reactive protein: interaction with the vascular endothelium and possible role in human atherosclerosis. Curr. Pharm. Des. 13(16), 1631–1645 (2007)

    Article  CAS  PubMed  Google Scholar 

  28. U. Derhaschnig, B. Jilma, Assessment of platelets and the endothelium in patients presenting with acute coronary syndromes: is there a future? Thromb. Haemost. 102(6), 1144–1148 (2009)

    CAS  PubMed  Google Scholar 

  29. G.Y. Lip, A. Blann, von Willebrand factor: a marker of endothelial dysfunction in vascular disorders? Cardiovasc. Res. 34(2), 255–265 (1997)

    Article  CAS  PubMed  Google Scholar 

  30. G.D. Xiang, L. Xu, L.S. Zhao, L. Yue, J. Hou, The relationship between plasma osteoprotegerin and endothelium-dependent arterial dilation in type 2 diabetes. Diabetes 55(7), 2126–2131 (2006)

    Article  CAS  PubMed  Google Scholar 

  31. G.D. Xiang, J.H. Pu, L.S. Zhao, H.L. Sun, J. Hou, L. Yue, Association between plasma osteoprotegerin concentrations and urinary albumin excretion in type 2 diabetes. Diabetes Med. 26(4), 397–403 (2009)

    Article  CAS  Google Scholar 

  32. S. Beer, F. Feihl, J. Ruiz, I. Juhan-Vague, M.F. Aillaud, S.G. Wetzel, L. Liaudet, R.C. Gaillard, B. Waeber, Comparison of skin microvascular reactivity with hemostatic markers of endothelial dysfunction and damage in type 2 diabetes. Vasc. Health Risk Manag. 4(6), 1449–1458 (2008)

    CAS  PubMed  PubMed Central  Google Scholar 

  33. J.S. Beckman, W.H. Koppenol, Nitric oxide, superoxide, and peroxynitrite: the good, the bad, and the ugly. Am. J. Physiol. 271(5 Pt 1), C1424–C1437 (1996)

    CAS  PubMed  Google Scholar 

  34. C. Gazzaruso, A. Coppola, T. Montalcini, E. Baffero, A. Garzaniti, G. Pelissero, S. Collaviti, A. Grugnetti, P. Gallotti, A. Pujia, S.B. Solerte, A. Giustina, Lipoprotein(a) and homocysteine as genetic risk factors for vascular and neuropathic diabetic foot in type 2 diabetes mellitus. Endocrine 41(1), 89–95 (2012)

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by Natural Science Foundation of Hubei Province (Nos. 2011CDA002 and 2009CDB427).

Conflict of interest

The authors do not have any conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Department of Endocrinology, Wuhan General Hospital of Guangzhou Command, Wuluo Road 627, Wuhan, 430070, Hubei, People’s Republic of China

    Lin Xiang, Guangda Xiang, Junxia Zhang, Ling Yue & Linshuang Zhao

Authors
  1. Lin Xiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guangda Xiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Junxia Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ling Yue
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Linshuang Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guangda Xiang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Xiang, L., Xiang, G., Zhang, J. et al. Contrast agent suppresses endothelium-dependent arterial dilation after digital subtraction angiography procedure in patients with diabetic foot. Endocrine 46, 505–511 (2014). https://doi.org/10.1007/s12020-013-0095-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-013-0095-8

Keywords

Search

Navigation