Endothelial dysfunction and the state of the microcirculatory bed in patients with obliterating atherosclerosis of the arteries of the lower extremities of the femoral-popliteal-tibial segment

Introduction. Endothelial dysfunction is a predictor of the development and progression of atherosclerosis, in particular, obliterating atherosclerosis of the arteries of the lower extremities.

The purpose of the study. To study the relationship between endothelial dysfunction and the state of the microcirculatory bed in patients with obliterating atherosclerosis of the arteries of the lower extremities with lesions of the femoral-popliteal-tibial segment.

Materials and methods of research. The content of markers of endothelial dysfunction, endothelium-dependent vasodilation of the brachial artery and microcirculatory bed was assessed in 135 patients with obliterating atherosclerosis of the arteries of the lower extremities of the femoral-popliteal-tibial segment with stage III-IV according to the Fontaine-Pokrovsky classification. The patients were divided into two groups, one group with stage III ischemia, the other with stage IV limb ischemia.

Results and discussion. The results of the study showed that there is a statistically significant increase in the level of markers of endothelial dysfunction, a decrease in endothelium-dependent vasodilation of the brachial artery. Higher values of these parameters were found in patients with stage IV ischemia. In patients with grade III limb ischemia, according to computer capillaroscopy, the number of linear working capillaries was 5,5±2,4 pcs. per 1 mm², and the number of working capillaries by area was 16,7±5,3 pcs. per 1 mm², with grade IV ischemia, the number of linear working capillaries was 3,3±1,3 pcs. per 1 mm², and the number of working capillaries by the area is 5,7± 2,8 pieces per 1 mm².

Conclusion. In case of obliterating atherosclerosis of the arteries of the lower extremities of the femoral-popliteal-tibial segment with stage III-IV, according to the Fontaine-Pokrovsky classification, the phenomenon of endothelial dysfunction and changes in the microcirculatory bed, more pronounced in the IV degree of ischemia, is noted.

1. Kuznetsov M.R., Turkin P.Y., Guseva T.V. et al. Conservative therapy of obliterating atherosclerosis: modern trends and new perspectives. Medicine, 2014, № 1, рр. 96–101. (In Russ.)

2. Clinical angiology. Manual for physicians. Edited by A.V. Pokrovsky. In two volumes. Т. 1. M. : Medicine, 2004, 808 р. (In Russ.)

3. National recommendations for the management of patients with arterial diseases of the lower extremities. Angiology and Vascular Surgery, 2013, № 19. (In Russ.)

4. Kazantsev A.V., Korymasov E.A. Choice of the method of treatment of obliterating atherosclerosis of lower limb arteries on the basis of predicting the course of the disease. Surgical Practice, 2017, № 1, рр. 33–37. (In Russ.)

5. Tishchenko I.S., Zolkin V.N., Tarabkin A.S. et al. Long-term results of infrainguinal bypasses in critical lower limb ischemia. Angiology and Vascular Surgery, 2021, № 27, рр. 121–126. (In Russ.)

6. Sukhovatykh B.S., Sukhovatykh M.B., Grigoryan A.Y., et al. Choice of surgery for lesions of the femoral-femoral-costal segment and doubtful outflow tracts. Angiology and Vascular Surgery, 2019, № 25 (2), рр. 111–116. (In Russ.)

7. Zhitova V.A., Chernukha S.N. Use of capillaroscopy for diagnostics of peripheral blood circulation disorders. Actual problems of modern medicine, 2013, № 13, рр. 231–235. (In Russ.)

8. Pushkareva T.A., Koryakina L.B., Runovich A.A., Kurilskaya T.E. Criteria for assessing endothelial dysfunction and ways to correct it (literature review). Clinical laboratory diagnostics, 2008, № 5, pp. 3–7. (In Russ.)

9. Shvalb P.G., Kalinin R.E. New prospects for determining the functional state of the endothelium in the surgical treatment of obliterating atherosclerosis of the arteries of the lower extremities. Angiology and vascular surgery, 2008, vol. 14, № 3, pp. 173–174. (In Russ.)

10. Almasri J., Adusumalli J., Asi N., Lakis S., Alsawas M., Prokop L.J., Bradbury A., Kolh P., Conte M.S., Murad M.H. A systematic review and meta-analysis of revascularization outcomes of infrainguinal chronic limbthreatening ischemia. J Vasc Surg., 2018, Aug; № 68(2), рр. 624–633. https://doi.org/10.1016/j.jvs.2018.01.06611

11. Giusca S., Raupp D., Dreyer D., Eisenbach C., Korosoglou G. Successful endovascular treatment in patients with acute thromboembolic ischemia of the lower limb including the crural arteries. World J Cardiol., 2018, Oct 26; № 10(10), рр. 145–152. https://doi.org/10.4330/wjc.v10.i10.145