Macrohemodynamic and microcirculation state in patients with occlusive-stenotic lesions of the main arteries of the lower extremities in various types of revascularizing interventions

Objective. The aim was to study the state of macrohemodynamics, microcirculatory bed and their relationship in patients with occlusive-stenotic lesions of the aorto-iliac-femoral arterial segment before and after revascularizing operations. Materials and methods. The results of the analysis of macrogemodynamic and microcirculatory bed state in 330 patients with obliterating atherosclerosis of lower limb arteries in various types of revascularizing interventions are presented: femoral-popliteal (group I, n=140), aorto-femoral (group II, n=97) bypass surgery, angioplasty with iliac artery stenting (group III, n=93). Results. There was a decrease in microcirculation in group I - 2.39 times, p<0.001, II - 3 times, p<0.001, III - 2.31 times, p<0.001, capillary blood flow reserve - in group I 1.63 times, p<0.001, II - 2.18 times, p<0.001, III - 1.77 times, p<0.001 and an increase in arterial-venular bypass regardless of the level of damage, as well as an oppression of endothelial mechanism and an increase in neurogenic mechanisms of regulation of microcirculation in all groups. Surgeries do not normalize microhemodynamics. Correlation interrelations of macrohemodynamics, changes in clinical status and microcirculation indices both in basal blood flow and under conditions of post-occlusive hyperemia were established. Changes in clinical status after surgery and bypass surgery had a negative-oriented correlation in all study groups (r=-0.2-0.3, p<0.05-0.01), and ankle-brachial index before and after surgery and RCC - the positive-oriented relationship (r=0.2-0.4, p<0.05-0.001). Conclusion. The state of microcirculation affects the change in clinical status after surgery, in this regard, it is necessary to take into account the parameters of microcirculation disorders and the mechanisms of regulation of tissue blood flow in surgical revascularization.

облитерирующий атеросклероз артерий нижних конечностей, реваскуляризующие вмешательства, макрогемодинамика, микроциркуляторное русло, механизмы регуляции тканевого кровотока, окклюзионные функциональные пробы, лазерная допплероская флоуметрия, obliterating atherosclerosis of lower extremity arteries, revascularizing interventions, macrohemodynamics, microcirculatory bed, mechanisms of regulation of tissue blood flow, occlusive functional tests, laser Doppler flowmetry