The functional state of peripheral perfusion in patients with combined lower limb ischemia and Type 2 diabetes mellitus during revascularization of the main arteries
Objectives. The study focuses on the state of microcirculatory blood flow (MBF) and some features of tissue metabolism in patients with combined lower limb ischemia (CLLI) and Type 2 diabetes mellitus (DM) during revascularization of the main arteries. Methods. The MBF functional state and tissue me...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Meshalkin National Medical Research Center
2015-10-01
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| Series: | Патология кровообращения и кардиохирургия |
| Subjects: | |
| Online Access: | http://journalmeshalkin.ru/index.php/heartjournal/article/view/10 |
| Summary: | Objectives. The study focuses on the state of microcirculatory blood flow (MBF) and some features of tissue metabolism in patients with combined lower limb ischemia (CLLI) and Type 2 diabetes mellitus (DM) during revascularization of the main arteries. Methods. The MBF functional state and tissue metabolism of the lower limbs in patients with chronic lower limb ischemia (CLLI) were studied by using laser Doppler flowmetry (LDF) measured in perfusion units (perf. u.) and transcutaneous oximetry (ТсрО <sub>2</sub>, mm Hg). The patients were broken down into two groups: the first group included 53 patients with CLLI, while 41 patients with combined CLLI and Type 2 diabetes mellitus (DM) formed the second group. Results. According to LDF data the baseline MBF had no intergroup differences: the first group - 3.5 (1.2-5.6) perf. u., the second one - 4.1 (1.3-5.8) perf. u. (p> 0.05). The lowest level of ТсрО <sub>2</sub> was observed in the second group - 25.3 (16.2-28.9) mm Hg as compared with 34.1 (29.8-39.3) mm Hg (p <0.05) in the first group. According to occlusion test data, the functional state of peripheral blood flow before revascularization in both groups was disturbed (capillary blood flow reserve (CR) less than 200%). In the second group CR was reduced to a greater extent (p <0.05). In the long-term period after revascularization there was a statistically significant increase in MBF, ТсрО <sub>2</sub> and CR and reserve ТсрО <sub>2</sub> (p <0.05) in the 1st group. A statistically significant increase in ТсрО <sub>2</sub> was noted in patients of the 2nd group, with low values of ТсрО <sub>2</sub> and CR unchanged during the post-occlusion hyperemia phase. At long-term follow-up after revascularization the rate of restenosis in the second group was 38%, while in the first one - 12% (p <0.05). Conclusions. Glucose metabolism disorders in patients with CLLI lead to a significant reduction of MBF reserves (capillary blood flow reserve CR is less than 130%), as well as to a low level of tissue metabolism (ТсрО <sub>2</sub> is less than 30 mm Hg) as compared with CLLI patients without DM. Expressed abnormalities of the functional state of peripheral MBF (CR is less than 120%) and metabolism of peripheral tissues (ТсрО <sub>2</sub> is less than 20 mm Hg.) double the risks of restenosis in the long-term period after revascularization. |
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| ISSN: | 1681-3472 2500-3119 |