AbstractThe 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.
Guch АO. Faktory razvitiya khronichekoy arterialnoy nedostatochnosti pri sochetannykh porazheniyakh bryushnoy chasti aorty i perifericheskikh arteriy. Khirurhiia Ukrainy. 2002;2:74-75.
Guch АA, Klimenko IT, Vlaykov GG, Shuvalova IN. Izmeneniya regionarnoy gemodinamiki i mikrotsirkulyatsiyi v tkanyakh nizhnikh konechnostey u bolnykh s obliteriruyushchim aterosklerozom v I-II stadiyi. Klinichna khirurhiia. 2003;6(724):25-27.
Pyptiuk OV. Changes of erythrocytic morphology, indices of lipid peroxidation and blood plasma antioxidant defense in the presence of chronic critical lower extremities ischemia and their dynamics after surgical treatment. Sertse і sudyny. 2005;1(9):88-95.
Belhadj N, Lahmer, Brouri MA. Prevalence of lower limb arteriopathy obliterans in the town hypertensive of Sidi Bel-Abbès. Annales de Cardiologie et d'Angéiologie. 2015;64(1):62-65.
Higashi Y, Miyata T, Shigematsu H, Origasa H, Fujita M, Matsuo H, et al. Baseline Characterization of Japanese Peripheral Arterial Disease Patients - Analysis of Surveillance of Cardiovascular Events in Antiplatelet-Treated Arteriosclerosis Obliterans Patients in Japan (SEASON). Circ J. 2016;80(3):712–721. http://doi.org/10.1253/circj.CJ-15-1048 PMid 26841805
Gottsäter A. Managing risk factors for atherosclerosis in critical limb ischaemia. Eur J Vasc Endovasc Surg. 2006 Nov;32(5):478–83. http://doi.org/10.1016/j.ejvs.2006.03.007 PMid 16631394
Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG; TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). European Journal of Vascular and Endovascular Surgery. 2007;45 (Suppl S):S5-67.
Chobanian A V, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertens (Dallas, Tex 1979). 2003 Dec;42(6):1206–1252. http://doi.org/10.1161/01.HYP.0000107251.49515.c2 PMid 14656957
Singer DRJ, Kite A. Management of hypertension in peripheral arterial disease: does the choice of drugs matter? Eur J Vasc Endovasc Surg. 2008 Jun;35(6):701–708. http://doi.org/10.1016/j.ejvs.2008.01.007 PMid 18375152
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.