SKIN MICROCIRCULATION STATE IN DIFFERENT DEGREES OF ARTERIAL INSUFFICIENCY IN PATIENTS WITH INTERMITTENT CLAUDICATION

Background. High prevalence and a poor prognosis of lower-extremity atherosclerotic arterial disease determine intermittent claudication (IC) as a pressing problem. It is known that about 40% of patients with IC can rely only on drug therapy carried out at the microcirculation (MC) level. Thus, the aim of the study is to reveal functional features of MC shifts in patients with IC of different degrees of arterial insufficiency. Material and Methods. The study included 72 male patients with angiographically confirmed obliterating atherosclerosis of the lower extremities, IC stage IIb, ankle-brachial index (ABI)≤ 0.85 and 15 healthy men (mean age 45.0±14.2 years). The patients were divided into 2 groups: group 1 with ABI≥0.55, (n=49) and group 2 with ABI<0.55 (n=23). The groups were matched for age (65.1±6.6 and 68.7±6.1 years), for number of patients with arterial hypertension and concomitant ischemic heart disease. All patients received background therapy including statins, aspirin, and if necessary, antihypertensive drugs. Assessment of skin MC was performed by laser Doppler flowmetry. Results. Analysis of the structure of hemoperfusion fluctuation rhythms showed a significant increase in the amplitude of the neurogenic modulation range in patients of the 2nd group compared to group 1 accounted to 0.72±0.48 perfusion units (pfu) vs 0.48±0.36 pfu, р=0.001, respectively and 0.43±0.26 pfu in healthy subjects, that indicates the dilation of the arterioles. At the same time, the myogenic tonus index indicating the state of precapillary sphincters, was significantly higher in patients of group 2 versus 1 group accounted to 84.9±57.7 units vs 59.0±31.5 units (р=0.015), respectively and 32.5±31.0 units in healthy group (р=0.03) that led to a significant decrease in nutritional blood flow (by 49% and 73%, respectively), increasing blood flow through arteriolo-venular shunts in 1 and 2 groups of patients (by 107.5% and 319%, р=0.002, respectively) and venous congestion causing more severe violation of blood rheology. Conclusion. The data obtained show severe MC disturbances in patients with IC that largely determines the severity and prognosis of the disease.

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