Impact of Muscular Arteries State on the Results of Surgical Treatment of Lower Limb Obliterating Atherosclerosis

Abstract

The failure of surgical treatment of obliterating atherosclerosis of the lower extremities may be associated with underestimation of changes in local hemodynamics, particularly in arterial hypertension.The objective of the research was to study the state of small muscular arteries in patients with arterial hypertension and its impact on the course of obliterating atherosclerosis and the results of surgical treatment.Materials and methods. There were examined 281 patients with obliterating atherosclerosis and 32 patients with arterial hypertension. Patients with obliterating atherosclerosis received presumptive treatment: an intravenous infusion of 4.2 g of L-arginine, forceful intra-arterial injection of 20-80 ml of infusate (heparin, pentoxifylline, procaine), femoral and gluteal nerve block. Results. Among hypertensive patients without obliterating atherosclerosis 13 persons had paraesthesia, feeling of coldness in the feet, platypodia, hypomyotonia, slow (63.7±1.3 sec) reactive hyperemia, arterial stenosis (40-45%), and low-amplitude or nonpulsative local blood flow. Among 97 patients with stable course of obliterating atherosclerosis 49 (50.5%) persons were diagnosed with uncomplicated arterial hypertension. Most of patients (80.3%) had single level occlusions of the iliac-femoral or femoral-popliteal segment. Presumptive treatment was effective in 87.1% of cases, reactive hyperemia was rapid (26.2±0.4 sec), local blood flow was pulsative. Arterial reconstruction with limb preservation for more than 1 year was performed in 12 (12.4%) cases. Among 184 patients with progressive course of obliterating atherosclerosis 162 (88.0%) persons were diagnosed with complicated arterial hypertension. Most of patients (83.7%) had multilevel lesions with diffuse stenosis or occlusions of the tibial arteries. Presumptive treatment was effective in 9.5% cases, reactive hyperemia was slow (106.3±2.7 sec), local blood flow was nonpulsative. Within 2 months 83 patients underwent above-knee amputation. Arterial reconstruction with limb preservation for more than 1 year was performed in 17 cases. Patients with arterial hypertension and obliterating atherosclerosis developed sclerosis of muscular arteries, intimal hyperplasia.Conclusions. Arterial hypertension causes lesions of small muscular arteries of the lower limbs. Hypertensive arteriopathy initiates the ascending development of obliterating atherosclerosis, causes hypertensive foot syndrome and unsatisfactory results of arterial reconstructions.