Macrovascular and Microvascular Disease in Diabetic Foot In Angiography

Running Head: NEUROPATHY 1
Macrovascular and Microvascular Disease in Diabetic Foot In Angiography
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NEUROPATHY 2
Introduction
Diabetes Mellitus is a global public health concern that affects children, teenagers, adults
and the elderly. The World Health Organization currently approximates that more than 200
million people globally have either type I DM or type 2 DM and this number is expected to
double by the year 2030. In 2010, mortalities from diabetes associated complications accounted
for 8% of the global deaths most of which were as a result of macrovascular and microvascular
complications (Cade, 2013). These complications result to blindness, premature deaths, foot
ulceration and even amputations. Besides, their management incurs significant social care and
healthcare costs. For proper health outcomes, it is mandatory that healthcare providers
understand the pathological processes of microvascular and microvascular complications. This
knowledge can be integrated with new imaging approaches such as angiograph which increase
prevention possibilities and early treatment.
Discussion
This paper explains the pathological process of foot neuropathy in angiography. A critical
analysis of the radiological appearances of diabetic foot in angiography and the best practice
imaging protocols that evaluates diabetic foot will be discussed. Besides, a description of the
treatment options of diabetic foot and expected outcomes for a patient will also be provided. An
understanding of the pathological process of microvascular and macrovascular disease in
diabetic foot has proven to improve treatment options and health outcomes (Donnelly & Horton,
2015). With this knowledge, nurses can identify and order for the most appropriate imaging
procedure and interpret findings.
Pathological Process and Medical Significance

NEUROPATHY 3
Neuropathy and diabetic foot is as a result of diabetic neuropathy. It is one of the most
significant complications of diabetes that leads to reduced functionality, amputations and
premature deaths. Diabetic foot often occurs as a consequence of several risk factors which
include: a longstanding hyperglycemia, smoking, high blood pressure, elevated lipids, and
exposure to neurotoxic agents (Noha & Doupis, 2016). The pathology occurs in a cascade of
series which include: polyol pathway, advanced glycation and oxidative stress.
In the polyol pathway, longstanding hyperglycemia contributes to an increase in the
intracellular glucose levels in nerves which results to saturation of the normal glucose pathway.
In advanced glycation, there is a non-enzymatic reaction of lipids, nucleotides and proteins with
excess glucose which disrupts the mechanisms of repair and integrity of nerves by interfering
with metabolism and transport. This leads to an increase in the production of free radicals which
directly damage small and huge blood vessels resulting to ischemia in nerves (Donnelly &
Horton, 2015). With nerve ischemia, susceptibility to minor and major injuries increases and
most injuries tend to develop into wounds that take long to heal, ending up with a diabetic foot.
Diabetes mellitus type two is highly devastating and one that causes many complications
in its progression (Vora & Buse 2012). Some of the chronic reported complications include
retinopathy, ketoacidosis, nephropathy, heart diseases, kidney failure, stroke, and amputations.
Most patients with diabetes present with symptoms of numbness, polyuria, malaise, excessive
thirst, poorly healing wound and nausea and vomiting (Fonseca, 2012). The assessment question
that should be asked include signs of blurring of vision that is normally caused by retinopathy,
nutritional practices and caloric intake as they could affect glycemic control of the patient, signs
of numbness that usually signify neuropathy, as well activity patterns to assess the level of
fatigue.

NEUROPATHY 4
Commonly Used Imaging procedures to evaluate Macrovascular and Microvascular
Disease in Diabetic Foot
Currently, the imaging procedures that are most commonly used to evaluate
macrovascular and microvascular disease in diabetic foot include; plain radiographs including X-
rays since they are readily available and inexpensive. A plain x-rays will show the key structural
and anatomic distribution of changes with osteomyelitis as the earliest sign (Reekers, 2016).
This can be noted through focal demineralization alongside the obscuring of the fat planes and
swelling of the soft tissues. A Computed Tomography (CT scan) is minimally used since it rarely
detects edema in the bone marrow and ischemia in nerves. Besides, patients are often exposed to
ionizing radiation (Reekers, 2016). A CT scan is only preferred in cases where the classical
features of involucre, sequestrate and cloacae for chronic osteomyelitis are visible.
Magnetic Resonance Imaging (MRI) is the widely used imaging modality to investigate
macrovascular and microvascular disease in diabetic foot. It provides a high resolution contrast
for tissues and is able to manipulate the images obtained for high sensitivity (Reekers, 2016).
MRI is able to diagnose the absence of osteomyelitis when there is infection of the soft tissue,
articular deformities, and calcifications in the arteries and gas in the soft tissue. Conventional
angiography is another imaging procedure that is done in especially in cases where surgical
endovascular and vascular treatment is considered (Reekers, 2016). Angiography helps to
describe the extent of atherosclerosis of small and big blood vessels.
Why Angiography Is Used to Evaluate Macrovascular and Microvascular Disease in
Diabetic Foot
Angiography is the recommended imaging procedure in evaluating macrovascular and
microvascular disease in diabetic foot since healing of most diabetic foot is often delayed or not