Introduction: Critical leg ischemia (CLI) is the most advanced stage of the chronic leg ischemia and its presence can result not only in local necrotic lesions but also in worsening of the patient’s general condition. In the paper, an assessment of the severity of an inflammatory process by the evaluation of the serum levels of inflammatory markers in patients with CLI was performed.
Material and methods: The study included 14 patients with CLI (rest pain or rest pain and necrosis) having Leriche syndrome and multilevel obstruction of the lower limb arteries, who underwent arterial reconstructive treatment in the aorto-femoral segment, as well as 6 control patients treated surgically because of an abdominal aortic aneurysm. Serum concentrations of inflammatory markers, such as C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor (TNF-alpha) and WBC, were measured during the perioperative period. The study evaluated the results of surgical treatment both in hospital and late postoperative (12 months) period including limb salvage, graft obstruction, limb amputation, the incidence of infections as well as cardiovascular events and deaths.
Results: In patients with CLI without necrotic lesions, CRP preoperative values ranged from 0.8 to 21 mg/L, and in patients with necrosis — from 3.5 to 116 mg/L (in comparison with the control group, higher CRP values were noted only in CLI patients with concomitant necrosis). There was a statistically significant difference in the preoperative IL-6 levels between the control group and CLI groups (higher levels in booth CLI groups was noticed without significant differences between the patients with and without necrosis). There were no differences in TNF-alpha levels between the groups with and without necrosis. In the early postoperative period, one patient underwent reoperation due to the thrombosis of the left branch of the aorto-bifemoral graft; another patient was qualified for the surgery due to bleeding from the stomach. There were no early deaths noticed. In one patient the crural level leg amputation was necessary, despite the reconstructive treatment.
Conclusions: Critical limb ischemia is a systemic disease constituting a threat to life and limb viability. Although the interdisciplinary preoperative preparation is important, the conservative preoperative treatment of critical limb ischemia brings no benefit of decreasing pro-inflammatory activity of the immune system. When planning arterial reconstruction, it is important to reduce perioperative trauma by using endovascular and hybrid techniques which allows for achieving better results.