ASSOCIATION BETWEEN DIABETIC-AUTONOMIC-C-FIBER-NEUROPATHY AND MEDIAL WALL CALCIFICATION AND THE SIGNIFICANCE IN THE OUTCOME OF TROPHIC FOOTLESIONS

The role of peripheral autonomic nerve failure in the development of m edial arterial calcification is discussed controversially in the liter ature. In addition, the influence of medial wall calcification in the development of trophic foot lesions is still not fully understood. We have compared 28 diabetic patients with cardiac autonomic failure and/ or decreased acetylcholine-induced sweat response with 22 diabetic pat ients without evidence of diabetic neuropathy and 27 healthy control s ubjects. A strong association was found between medial wall calcificat ion and diminished heart rate variation (p.001) or diminished peripher al sweat response (p < 0.001). Only one subject in the control group e xhibited a calcification of the tunica media in the lower limb. Medial calcinosis was accompanied by a significant rise of systolic ankle bl ood pressure (p < 0.05). In addition, there was a strong relationship between medial wall calcification and trophic foot lesions (p < 0.0001 ). Our results demonstrate a strong association between sympathetic C- fibre neuropathy and the development of medial wall calcification, as well as between calcification of the tunica media and trophic foot ulc eration. Further investigation is necessary to determine whether there is a causal connection between medial arterial sclerosis and diabetic foot ulceration, or whether both are independent consequences of diab etic neuropathy.