Reperfusion as a marker of success of distal revascularisation

Murray, Anna Marie (2014). Reperfusion as a marker of success of distal revascularisation. University of Birmingham. M.D.

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Abstract

Objectives: To determine whether skin microvascular perfusion and reactivity in critical limb ischaemia (CLI) is more enhanced following surgical, compared to endovascular treatment and if this is supplemented with concomitant improvement in clinical and haemodynamic parameters.

Design: Prospective observational study of forty CLI patients with multi-level atherosclerotic arterial disease requiring infra-inguinal revascularisation.

Methods: Clinical assignment to surgical (n=30) or endovascular (n=10) treatment with six-week follow-up. Laser Doppler fluxmetry (LDF) was used to assess the time to peak (Tp), basal flux and vasoconstrictor mechanisms. Outcomes were compared with clinical improvement and pressure changes at the ankle and toe. Anthropometric measures and tissue tension were assessed for evidence of reactive lower limb oedema.

Results: The surgical group showed a significant decrease in Tp (100±4 to 59±7, p<0.001) and some restoration of autoregulation, notably vasoconstriction in the foot on sitting (72.4±6.8 to 52.2±2.3, p0.05). Improvement in the anatomical severity of disease correlated with concomitant rise in toe pressures (p<0.001) but not with pressures at the ankle. Reactive oedema was more evident post-surgery, with associated increases in lower-limb tissue tension. Endovascular intervention ameliorates symptoms in the short-term but did not provide the same microvascular restoration.

Conclusions: Microvascular perfusion and reactivity is greatly improved at six-weeks after surgical revascularisation but not after endovascular intervention.

Type of Work:

Thesis (Higher Doctorates > M.D.)

Award Type:

Higher Doctorates > M.D.

Supervisor(s):