Microcirculation and biochemical markers of endothelial dysfunction after medical and surgical treatment in patients with peripheral arterial disease

Abstract

Introduction . Тhe peripheral (PAD) arteries of lower extremities are most commonly suffers from the peripheral arterial disease that can be asymptomatic for a long time. Late clinical manifestation leads to reduction the quality of life and is often accompanied by limbs amputation. These cases are frequent when revascularization is not possible. The development of chronic limb ischemia (CLI) is associated with endothelial dysfunction (ED), oxidative stress and inflammation. The aim of this work is to study skin microcirculation and laboratory markers of ED in patients with PADs before and after medical treatment or operations. Materials and methods . The study included 17 healthy people (44–61 years old) and 38 patients (58–75 years old) with PAD, which were divided into four groups in accordance with the stage of CLI. The research protocol included biochemical and instrumental research methods to determine the functional status of the microcirculation system. Results . Significant differences in the values of biochemical markers and the results of instrumental studies of ED were obtained in groups with PAD compared with the control group. The study was fully repeated two weeks after treatment. It revеals that direct endovascular and reconstructive methods for revascularization of the lower extremities, simultaneous or staged elimination of the pathological focus, complex conservative therapy are accompanied by a decrease in laboratory markers of ED and inflammation and an improvement in micro vessel regulation due to the neurogenic and endothelial mechanisms. The most significant differences were obtained in the group with atherosclerosis of low limb vessels, namely the von Willebrand factor (from 180±56 % before the treatment to 128±36 % after), endothelin (0.37±0.15 pmol/l before the treatment to 0.20±0.08 pmol/l) after, homocysteine (from 15±3 mcmol/l to 10±2 mcmol/l). Conclusions . It was found that the recovery of the main blood flow is accompanied by an improvement in the function of the microcirculation system, which can be detected both by specific biomechanical markers and instrumental methods for diagnosing ED.