Hemorheologic variables in critical limb ischemia before and after infrainguinal reconstruction

Plasma and whole blood viscosity are elevated in patients with intermittent claudication. The objectives of this study were to investigate whether critical limb ischemia influences hemorheologic variables and whether the rheologic variables in blood from the affected limb differ from the general circulation. We also intended to study whether successful infrainguinal reconstruction improved hemorheologic variables.

Ten consecutive patients with critical limb ischemia (CLI) underwent arterial reconstruction, one patient with profundaplasty and nine patients with bypass procedures. Venous blood was sampled from the antecubital vein (arm) and the femoral vein (leg) of the affected limb 1 day before and 1 month after surgery. Ten control subjects (matched according to age, sex, diabetic status, and renal insufficiency) were also sampled. Whole blood viscosity, plasma viscosity, erythrocyte aggregation tendency, and erythrocyte fluidity (the latter variable describing the deformability of the erythrocytes) were measured by means of rotational viscometry. Erythrocyte volume fraction was also determined. Fibrinogen was measured in the patients with CLI.

Erythrocyte fluidity, blood viscosity, and erythrocyte volume fraction were lower in patients with CLI than in control subjects (P <.01, P <.01, and P <.05, respectively). No major differences between cubital and femoral vein blood were seen before or after the operation in patients with CLI or in control subjects. Successful revascularization did not influence the hemorheologic variables, except for a decrease in blood viscosity in femoral vein blood (P <.05).

Hemorheologic properties was impaired in patients with CLI. Because no differences were seen between the systemic and local circulation and because no major improvement occurred 1 month after arterial reconstruction, other mechanisms besides local tissue ischemia may play a role.