open access

Vol 15, No 2 (2013)
Original articles
Published online: 2014-09-23
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Assessment of inflammatory markers concentration in patients with critical limb ischemia undergoing arterial reconstructive surgery

Tomasz Ruciński, Janusz Kuśmierz, Ewa Romuk, Ryszard Walas, Rafał Boczej, Marek Motyka
Chirurgia Polska 2013;15(2):124-133.

open access

Vol 15, No 2 (2013)
Original articles
Published online: 2014-09-23

Abstract

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.

Abstract

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.
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Keywords

tumor necrosis factor-alpha, interleukin 6, C-reactive protein, critical limb ischemia

About this article
Title

Assessment of inflammatory markers concentration in patients with critical limb ischemia undergoing arterial reconstructive surgery

Journal

Chirurgia Polska (Polish Surgery)

Issue

Vol 15, No 2 (2013)

Pages

124-133

Published online

2014-09-23

Bibliographic record

Chirurgia Polska 2013;15(2):124-133.

Keywords

tumor necrosis factor-alpha
interleukin 6
C-reactive protein
critical limb ischemia

Authors

Tomasz Ruciński
Janusz Kuśmierz
Ewa Romuk
Ryszard Walas
Rafał Boczej
Marek Motyka

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