Diabetic macroangiopathy. Medial calcifications, narrowing, rugosities, stiffness, norepinephrine depletion and reduced blood flow capacity in the leg arteries.

Abstract

Five quantitative studies performed to disclose and measure diabetic abnormalities in the leg arteries are reported and briefly discussed. A medial as well as an intimal disease was found in the diabetic leg arteries. Thus roentgenological medial calcification correlated to glucose intolerance in older non-diabetics and to diabetes duration in young insulin dependent diabetics. An intimal roughness was disclosed by arteriography in young insulin-dependent diabetic patients. The roughness grew worse the longer the diabetes persisted. The development of this abnormality did not take place simultaneous with the medial calcification, but was closely connected with another disclosed abnormality, a uniform arterial narrowing, quite unlike the well known abrupt narrowing in older patients. The existence of a uniform arterial narrowing in diabetic patients was confirmed by ultrasonography and the use of this technique further revealed arterial stiffness as a long-term diabetic phenomenon. A functional abnormality of the leg arteries of diabetic patients was disclosed by measurement of the postischemic peak blood flow in the leg in a 45 degree feet-down position. A vast destruction of the autonomic nerves of the peripheral arteries was demonstrated by measurement of the norepinephrine content post mortem in long-term diabetic patients. The results reported suggest a specific element in the large-vessel disease of diabetic patients.