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Peripheral Arterial Diseases in Type 2 Diabetes Mellitus: A Cross-sectional Study Using Ankle-Brachial Index |
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Sunaya Chandrashekar, Kalaivani V 1. Intern, Department of Surgery, MS Ramaiah Medical College, Bengaluru, Karnataka, India. 2. Associate Professor, Department of Surgery, MS Ramaiah Medical College, Bengaluru, Karnataka, India. |
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Correspondence Address : Sunaya Chandrashekar, Kalaivani V, Dr. Kalaivani V, MS Ramaiah Memorial Hospital New BEL Road MS Ramaiah Nagar, MSRIT Post, Bengaluru-560094, Karnataka, India. E-mail: dr.vani_rajan@yahoo.com |
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| ABSTRACT |  | ||||||||||||||||||||||||||||||||||||||
: Morphometry of body and neural arch of lumbar vertebrae is very crucial in manufacturing screws, interspinous implants as well as preoperative planning of surgeries involving dorsolumbar spine. Aim: To determine various dimensions of typical and atypical lumbar vertebrae. Materials and Methods: A descriptive osteological study was carried out which included 66 intact adult dry human lumbar vertebrae (53 typical and 13 atypical) which were free of any deformity or pathological features. All the 53 typical vertebrae were randomly obtained. The following parameters were measured with slide callipers- superior transverse diameter and superior antero-posterior diameters of vertebral foramen; transverse diameter, antero-posterior diameter and anterior height of vertebral body; width, height of pedicles; interpedicular distance; maximum thickness of lamina; length of transverse process; maximum length, maximum height and maximum central thickness of spinous process. The data was tabulated and analysed using Microsoft Excel software. Mean and standard deviation was calculated for each parameter. Unpaired t-test was applied and p-value was derived for parameters like width and height of pedicles, thickness of lamina and length of transverse process. The p-value<0.05 were considered as significant. Results: The vertebral foramen (superior transverse diameter- 20.41±2.54 mm, superior antero-posterior diameter- 13.3±2.04 mm); vertebral body (transverse diameter- 44.43±5.91 mm, antero-posterior diameter- 30.17±3.19 mm, anterior height- 24.01±1.84 mm); pedicle (width- 10.85±3.94 mm on left side and 11.04±4.01 mm on right side, height- 13.84±4.01 mm on left side and 13.8±1.93 mm on right side, interpedicular distance- 29.17±5.06 mm); lamina (thickness- 6.6±1.36 mm on left side and 6.85±1.34 mm on right side); transverse process (length- 20.94±4.01 mm on left side and 21.51±4.5 mm on right side); spinous process (maximum length- 26.01±3.73 mm, maximum height- 19.92±4.03 mm, maximum central thickness- 6.42±1.41 mm). The mean transverse diameter and antero-posterior diameter of vertebral foramen of atypical lumbar vertebrae were higher than those of the typical lumbar vertebrae and these differences were significant (p-value of 0.0001 for transverse diameter and p-value of 0.005 for antero-posterior diameter). Conclusion: Most of the parameters of atypical lumbar vertebrae were found to be more compared to those of typical lumbar vertebrae. This inference should be kept in mind during fixation of lumbar inter-spinous implants, designing of pedicular screws and spinal grafting. | |||||||||||||||||||||||||||||||||||||||
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| Keywords : Hyperglycaemia, Macrovascular complications, Microvascular complications | |||||||||||||||||||||||||||||||||||||||
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| INTRODUCTION |
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Diabetes mellitus is one of the leading non-communicable diseases of the 21st century. India with more than 62 million diagnosed diabetics is fast earning the title of ‘Diabetes Capital of the World” (1). Diabetes imposes a heavy toll on the vascular system, with both macrovascular and microvascular complications. PAD is one of the macrovascular complications of Type 2 DM (2). Prevalence of PAD is higher among diabetics and has a predilection for lower limbs. It has been hypothesised that the metabolic abnormality in the prediabetic phase predisposes to a more distal and aggressive atherosclerosis. Once diabetes has developed, this process is accelerated due to chronic hyperglycaemia, endothelial damage, non-enzymatic glycosylation and poly-neuropathy which in turn could lead to impaired vascular remodelling and collateral formation (3). PAD in extreme cases manifests as claudication or gangrene, but in most cases, goes by undetected. Up to 40% of patients with PAD are asymptomatic, while another 50% of patients describe a variety of leg symptoms different from classical intermittent claudication (4). PAD is a major cause of morbidity and mortality among diabetic population. As PAD becomes symptomatic, there is a decrease in quality of life and is associated with functional impairment (5). The development of intermittent claudication can significantly reduce walking speed and distance, resulting in a progressive loss of function and long term disability (6). In more extreme cases, Critical Limb Ischaemia (CLI) may develop, leading to ulceration of the foot (7). It is a major risk factor for lower extremity amputation and also a high likelihood of systemic cardiovascular disease and stroke (8). The proportion of diabetics with PAD has been difficult to determine due to its asymptomatic nature and presence of neuropathy. Also, there are several methodological challenges impeding the accurate diagnosis of the condition across different levels of health care setting. Measurement of ABI has emerged as a non-invasive and economical method of diagnosing PAD (9). The patient is diagnosed with PAD when ABI < 0.9 (10). An ABI <0.9 is used to diagnose PAD and is also a marker of increased morbidity and mortality from cardiovascular diseases (11). ABI has been validated against colour duplex scan and was found to be 82.6% sensitive and 100% specific in detecting PAD (12). Studies have been conducted both in health care centers as well as in the urban population for estimation of the prevalence of PAD among Type 2 diabetics. The studies conclude that a large proportion of diabetics have a decreased ABI below 0.9 (14),(14). However, there are no studies to establish diabetes as an independent risk factor for PAD in asymptomatic patients. Early diagnosis of PAD can help patients to effectively manage the condition and prevents its long term sequelae. This study attempts to estimate the hidden burden of asymptomatic PAD among Type 2 diabetes mellitus patients and hence emphasize on the importance of regular checking of ABI in diabetics for early diagnosis and management. | |||||||||||||||||||||||||||||||||||||||
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| TABLES AND FIGURES |
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Original article / research
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