Introduction

Microangiopathy, or dysfunction of small blood vessels, is closely linked to diabetic complications, such as nephropathy and retinopathy. Microangiopathy is also closely associated with the third complication of this triad, polyneuropathy, but its exact role in the development of nerve disease is uncertain. It is probably incorrect to conclude that microvascular disease is the primary trigger of neuropathic complications, an assumption that ignores direct neuronal damage. Instead, there is significant evidence that a unique neuroscience of diabetic neuropathy exists. The evidence that diabetes has direct impacts on sensory neuron structure and function independently of microan-giopathy is reviewed in depth elsewhere (1). Overall, it might be more accurate to depict chronic diabetes as involving nerve trunks, ganglion, and their respective microvessels in parallel, a process that can eventually lead to a vicious interacting cycle of damage. In some situations, such as focal nerve trunk ischemic insults or

From: Contemporary Diabetes: Diabetic Neuropathy: Clinical Management, Second Edition Edited by: A. Veves and R. Malik © Humana Press Inc., Totowa, NJ

mechanical nerve injury, the relative contribution of microangiopathy might be higher. Although, a detailed technical appraisal of relationships between nerve blood flow in published work and experimental neuropathy has been recently published separately, this review will highlight and summarize some of this controversy (2). In this work, aspects of nerve and ganglion blood flow and its measurement, models of ischemia, and evidence for diabetic peripheral nerve and ganglion microangiopathy are emphasized and reviewed.

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