Novosti
Khirurgii
This journal is
indexed in Scopus









Year 2022 Vol. 30 No 2

GENERAL & SPECIAL SURGERY

DOI: https://dx.doi.org/10.18484/2305-0047.2022.2.144   |  

V.A. LAZARENKO, E.A. BOBROVSKAYA

ANALYSIS OF MICROCIRCULATION PARAMETERS IN PATIENTS WITH THE DEVELOPMENT OF RESTENOSIS IN THE AREA OF ARTERIAL RECONSTRUCTION AFTER FEMORAL-POPLITEAL BYPASS SURGERY

Kursk State Medical University, Kursk,
The Russian Federation

Objective. To identify the features of microcirculation disorders in the development of restenosis of the arterial reconstruction zone in patients with obliterating atherosclerosis after femoral-popliteal stenting.
Methods. The study included patients (n=82) with obliterating atherosclerosis with grade IIB-III chronic arterial insufficiency, who underwent femoral-popliteal stenting. In 21 patients, the postoperative period proceeded without the development of restenosis of the arterial reconstruction zone (group I). Group II included 61 patients who developed restenosis of the arterial reconstruction zone during the year. The parameters of microcirculation were evaluated with the analysis of the amplitude-frequency spectrum (AFS) of blood flow oscillations prior and after revascularization.
Results. The microcirculation index (45.3%, p<0.001) and capillary blood flow reserve (49.2%, p<0.001) were found to be lower in patients of group II both initially prior and after revascularization (30.7%, p<0.001 and 51.4%, p<0.001) with significantly high values of arteriolo-venular bypass prior and post surgery (26.6%, p<0.001 and 41.9%, p<0.001), increasing after occlusion test compared with group I. In the amplitude-frequency spectrum of group II, a violation of the active components was noted due to the initial low value of the myogenic component (47.3%, p<0.001) and high neurogenic (35.5%, p<0.001) component with a significantly high index after the occlusion test (64.3%, p<0.05) compared to group I, not normalized after lower limb revascularization surgery, along with a violation of the function of passive mechanisms of blood flow modulation.
Conclusion. The development of restenosis after femoral-popliteal bypass surgery is accompanied by a pronounced violation of the state of microcirculation and the balance of the mechanisms of blood flow modulation, not normalized after lower limb revascularization surgery. The study of microcirculation indicators with an assessment of the functional activity of microcirculatory blood flow prior and after surgery will allow verifing the existing disorders and personalizing the treatment tactics.

Keywords: microcirculation, atherosclerosis, restenosis, femoral-popliteal bypass surgery, laser Doppler flowmetry
p. 144-151 of the original issue
References
  1. Arakelyan VS. Ways of decreasing incidence of complications in patients after endured reconstructive and endovascular operations on lower limb arteries. Angiologija i Sosudistaja Hirurgija. 2020;26(1):165-73. doi: 10.33529/ANGIO2020106 (In Russ.)
  2. Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mills JL, Ricco JB, Suresh KR, Murad MH, Aboyans V, Aksoy M, Alexandrescu VA, Armstrong D, Azuma N, Belch J, Bergoeing M, Bjorck M, Chakfé N, Cheng S, Dawson J, Debus ES, Dueck A, Duval S, Eckstein HH, Ferraresi R, Gambhir R, Gargiulo M, Geraghty P, Goode S, Gray B, Guo W, Gupta PC, Hinchliffe R, Jetty P, Komori K, Lavery L, Liang W, Lookstein R, Menard M, Misra S, Miyata T, Moneta G, Munoa Prado JA, Munoz A, Paolini JE, Patel M, Pomposelli F, Powell R, Robless P, Rogers L, Schanzer A, Schneider P, Taylor S, De Ceniga MV, Veller M, Vermassen F, Wang J, Wang S; GVG Writing Group for the Joint Guidelines of the Society for Vascular Surgery (SVS), European Society for Vascular Surgery (ESVS), and World Federation of Vascular Societies (WFVS). Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. Eur J Vasc Endovasc Surg. 2019 Jul;58(1 Suppl):S1-S109.e33. doi: 10.1016/j.ejvs.2019.05.006
  3. Belov Iu V, Vinogradov OA, Ulianov ND, Dziundzia AN. Prognosis of revascularization surgery results on lower limbs arteries on the basis of assessment of regional blood flow. Kardiologiya i Serdechno-Sosudistaya Khirurgiya. 2014;7(5):62-67. https://www.mediasphera.ru/issues/kardiologiya-iserdechnososudistayakhirurgiya/2014/5/031996-63852014512 (In Russ.).
  4. Gorokhovsky SY, Lyzikov AA, Kaplan ML, Tihmanovich VE. Expediency and options for functional control in determining the extent of surgery for occlusive lesions of the lower extremity arteries. Novosti Hirurgii. 2020;28(5):505-14. doi: 10.18484/2305-0047.2020.5.505 (In Russ.).
  5. Ikeoka K, Watanabe T, Shinoda Y, Minamisaka T, Fukuoka H, Inui H, Ueno K, Inoue S, Mine K, Hoshida S. Pressure- and Velocity-based physiological assessment of stenotic lesions at hyperemia in superficial femoral artery disease: importance of hyperemic stenosis resistance. Ann Vasc Dis. 2019 Sep 25;12(3):362-66. doi: 10.3400/avd.oa.19-00034
  6. Okamoto S, Iida O, Nakamura M, Yamauchi Y, Fukunaga M, Yokoi Y, Soga Y, Zen K, Hirano K, Suematsu N, Suzuki K, Shintani Y, Miyashita Y, Urasawa K, Kitano I, Yamaoka T, Ohura N, Hamasaki T, Uematsu M, Nanto S; OLIVE Investigators. Postprocedural skin perfusion pressure correlates with clinical outcomes 1 year after endovascular therapy for patients with critical limb ischemia. Angiology. 2015 Oct;66(9):862-66. doi: 10.1177/0003319715569907
  7. Zabolevanija arterij nizhnih konechnostej. Klinicheskie rekomendacii [Jelektronnyj resurs]. Moscow, RF; 2016. 94 p. Available from: https://racvs.ru/clinic/files/2016/Diseases-lower-limb-arteries.pdf (In Russ.).
  8. Krupatkin AI, Sidorov VV. Funkcionalnaja diagnostika sostojanija mikrocirkuljatorno tkanevyh sistem: kolebanija, informacija, nelinejnost: ruk dlja vrachej. Moscow, RF: LIBROKOM; 2013. 496 p. (In Russ.).
  9. Jasperse JL, Shoemaker JK, Gray EJ, Clifford PS. Positional differences in reactive hyperemia provide insight into initial phase of exercise hyperemia. J Appl Physiol (1985). 2015 Sep 1;119(5):569-75. doi: 10.1152/japplphysiol.01253.2013
  10. Treml B, Kleinsasser A, Stadlbauer KH, Steiner I, Pajk W, Pilch M, Burtscher M, Knotzer H. Cutaneous microvascular blood flow and reactivity in hypoxia. Front Physiol. 2018 Mar 6;9:160. doi: 10.3389/fphys.2018.00160. eCollection 2018
  11. Ichinose M, Nakabayashi M, Ono Y. Difference in the integrated effects of sympathetic vasoconstriction and local vasodilation in human skeletal muscle and skin microvasculature. Physiol Rep. 2019 Apr;7(7):e14070. doi: 10.14814/phy2.14070
  12. Lazarenko VA, Bobrovskaya EA, Putintseva EV, Bogdanova YuG, Zherebilov NN.The assessment of the microcirculation system and mechanisms of regulation of tissue blood flow in patients with obliterating atherosclerosis in various degrees of the arterial bed. Kurskij nauch-prakt vestn Chelovek i Ego Zdorove. 2011;(3):82-86. https://cyberleninka.ru/article/n/otsenka-sostoyaniya-sistemy-mikrotsirkulyatsii-i-mehanizmov-regulyatsii-tkanevogo-krovotoka-u-bolnyh-obliteriruyuschim (In Russ.)
  13. Streltsova NN, Vasilyev AP, Bessonov IS, Kolunin GV. The microcirculatory changes in patients with intermittent claudication after endovascular restoration of main blood flow to the extremity. Regionarnoe Krovoobrashchenie i Mikrotsirkuliatsiia. 2018;17(2):42-48. doi: 10.24884/1682-6655-2018-17-2-42-48 (In Russ.)
  14. Vasilev AP, Strelcova NN, Bessonov IS, Korotkih AV. State of microcirculation in patients with atherosclerosis and diabetes mellitus after limb revascularization. Angiologija i Sosudistaja Hirurgija. 2020;26(1):22-29. doi: 10.33529/ANGIO2020112 (In Russ.)
  15. Ruzsa Z, Róna S, Tóth GG, Sótonyi P, Bertrand OF, Nemes B, Merkely B, Hüttl K. Fractional flow reserve in below the knee arteries with critical limb ischemia and validation against gold-standard morphologic, functional measures and long term clinical outcomes. Cardiovasc Revasc Med. 2018 Mar;19(2):175-81. doi: 10.1016/j.carrev.2017.07.007
Address for correspondence:
305041, Russian Federation,
Kursk, K.Marx Street, 3,
Kursk State Medical University,
the Department of Surgical Diseases
of the Institute of Continuing Education,
tel. +7 4712 58-81-32,
e-mail: azaroks@mail.ru,
Lazarenko Victor A.
Information about the authors:
Lazarenko Victor A., MD, Professor, Head of the Department of Surgical Diseases of the Institute of Continuing Education, Kursk State Medical University, Kursk, Russian Federation.
https://orcid.org/0000-0002-2069-7701
Bobrovskaya Elena A., MD, Associate Professor, the Department of Surgical Diseases of the Institute of Continuing Education, Kursk State Medical University, Kursk, Russian Federation.
https://orcid.org/0000-0003-3898-5522
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