THE STATE OF THE MICROCIRCULATORY AND ENDOTHELIAL SYSTEMS DURING REVASCULARIZATION OF THE MAIN ARTERIAL BED IN CONDITIONS OF CHRONIC ARTERIAL INSUFFICIENCY

Abstract

SUMMARY. Postoperative complications of reconstructive surgery on the main vessels reach the level of 2.7–3.2 %. One of the reasons for unsatisfactory results of revascularization of the lower extremities is the development of reperfusion-reoxygenation syndrome in patients operated in conditions of chronic arterial insufficiency. The degree of manifestation, the phasing of these phenomena is difficult to predict before reconstructive surgery. They depend on a number of factors, including the degree of arterial ischemia, the level of damage, the volume of collateral circulation, the state of the vascular endothelium, the cellular adaptation mechanism. Given the above, it is necessary to propose methods of preoperative preparation, the main purpose of which would be to increase cellular adaptation mechanisms to the released oxygen radicals in the sudden oxygenation of tissues of the lower extremity.

The aim – to study the state of the endothelial system and microcirculatory tract during revascularization of the occlusive process of the main arterial bed in conditions of chronic arterial insufficiency.

Material and Methods. The study included 41 patients with atherosclerotic occlusion of the main arteries of the lower extremities. In 19 patients different variants of atherosclerotic occlusion of the aorto-femoral segment were diagnosed, in 22 stenotic-occlusive process of the femoral-popliteal segment was revealed. There are two groups of patients. Group I – 18 (43.90 %) patients, preoperative preparation was carried out according to the protocol of treatment of the pathological process. Group II – 23 (56.10 %) patients who were treated modified preoperative preparation. Endothelial dysfunction was assessed by determining the level of a number of markers, namely: P-selectin, E-selectin, tissue plasminogen activator (t-PA), endothelin-1, vascular endothelial adhesion molecules type 1 (sVCA M-1), circulating endothelial cells CEC). The level of nitric oxide metabolites (NO), vascular endothelial growth factor (VTGF) was determined by enzyme-linked immunosorbent assay using the KHGO111-VTGF analyzer and Griss reagent -NO. Laser Doppler flowmetry (LDF) was used to obtain information on changes in capillary blood flow and arterio-venous shunting. The study was performed in the area of the base of the big toe. The basal level of tissue perfusion (PT), erythrocyte concentration (CE) was determined. To evaluate the results, the ratio of FPT/PCT (regional systolic pressure) – skin pressure index (BMI) was determined. The resistance index of the microcirculatory tract (IOMR) was calculated by the Hagen-Poisel formula as the ratio of perfusion pressure to the integral value of skin perfusion.

Results. In patients who received preoperative preparation according to the treatment protocol, in the early postoperative period there was a significant increase in blood levels of CEC, Endothelin-1 with a significant decrease in P-selectin, E-selectin and a slight decrease in NO and VEGF.

When analyzing the results of the study of the level of endothelial dysfunction in two groups of patients, a significant difference was found. In the second group of patients the level of endothelial dysfunction, both in the preoperative stage of the study and in the early postoperative period is significantly lower than in the first group of patients. The latter gives the right to claim that preoperative preparation with drugs included in the modified preparation for revascularization increases the resistance of cells to the damaging effects of oxygen free radicals.

In the study of the functional state of the microcirculatory tract in patients of group I, found at the preoperative stage low, within 1.03±0.07, cm/s., The level of GCC. The latter largely depends on the level of the pancreas and CE, the indicators of which in this period were at the level of 18.23±2.25 PE and 16.34±4.65 um. PN by 21.1 % (p<0.05) and a slight increase of 8.9 % in the content of CE. The latter contributed to a 17.5 % increase in the level of SSC.

In the comparative analysis of the characteristics of the functional state of the microcirculatory tract in patients of two groups found that patients with modified preoperative preparation, both in the preoperative and especially in the early postoperative period, their significant growth. Such changes contributed to a 1.6–fold increase (p<0.05) in oxygen saturation of the lower extremities compared to oxygen saturation in patients receiving preoperative preparation according to the treatment pathology protocol.

Conclusions. 1. Revaccularization of the arterial bed in the conditions of СAІ contributes to a significant reduction in the level of endothelial dysfunction and deterioration of the functional capacity of the microcirculatory tract.

1. Modified preoperative preparation of patients for revascularization of the arterial bed in the conditions of СAІ makes it possible to reduce the level of endothelial dysfunction and improve the functional capacity of the microcirculatory tract.