CAROTID ARTERY HEMODYNAMICS IN PATIENTS WITH CHRONIC ISCHEMIA OF LOWER LIMBS ASSOCIATED WITH INTERNAL CAROTID ARTERY LESIONS

Kazakov Yu.I., Hatypov M.G.
Department of Cardiovascular Surgery, Regional Clinical Hospital, Medical Academy,
Tver, Russia

A peak systolic blood velocity (Vpeak) and index of vascular resistance (IR) in carotid arteries were registered by Doppler ultrasound and analyzed in 134 patients with different stages of atherosclerosis obliterans of lower limb arteries. All patients were divided into 2 groups: first group consisted from patients without lesions of brachiocephalic arteries (107 patients); second group (27 patients) – with concomitant unilateral lesion of internal carotid artery (ICA). In control group hemodynamics was assessed in 20 patients with unilateral stenosis of ICA without lower limb atherosclerosis. Significant decrease of blood flow (for 20%) in common carotid artery (CCA) was observed only in patients with decompensated collateral circulation and advanced pain syndrome. In group with advanced pain syndrome and 50-70% of ICA occlusion Vpeak reduction in CCA was as less as 39% (p<0.05) unilaterally and 18% contralaterally. Minimal Vpeak in CCA (up to 25 sm/sec) was registered in this group in patients with more than 90% of ICA stenosis. Dramatic decrease of Vpeak in CCA was observed in patients with hypokinetic type of central hemodynamics (cardiac index – CI=1.78±0.03 1/min×m²). In cases of 70-90% of ICA stenosis Vpeak reduced by 41% (p<0.01) unilaterally and 21% (p<0.05) contralaterally. Obtained results indicate that in patients with III-IV stages of ischemic lesions of lower limb arteries and advanced pain syndrome as well as in patients with hypokinetic type of hemodynamics or concomitant ICA lesions Doppler ultrasound registers threatening reduction of blood velocity in carotid arteries. Such patients must be assigned to the group of high risk of ischemic cerebrovascular disorders. Severe chronic ischemia of lower extremities must be considered as unfavorable factor worsening cerebral perfusion reserve in patients with concomitant ICA lesions.

P. 56-62

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