EVALUATION OF MICROCIRCULATION IN ELDERLY PATIENTS WITH VENOUS TROPHIC ULCERS

R.Z. Losev, Yu.A. Burov, Ye.G. Mikulskaya, Ye.A. Yakusheva
Ghair of Hospital Surgery, Medical Faculty, Saratov State Medical University, Department of Vascular Surgery,
Clinical Hospital №1,
Saratov, Russia

Altogether 112 patients over 50 years of age suffering from varicosity and chronic trophic ulcers of the distal limb segments were examined. The work was based on an analysis of the microcirculatory flow in lower limb tissues (laser Doppler flowmetry, BLF 21 system, Transonic Systems Inc., USA) and on the evaluation of tissue metabolism by measuring partial oxygen and carbon dioxide tension (percutaneous polarography; TCM-3 system, Radiometry Company, Denmark). The postischemic and orthostatic tests were used to assess the functional microcirculatory reserve.

The data obtained indicate local tissue hypoxia in elderly patients with venous trophic ulcers associated with an increase of the basal flow only in the lower third of the leg. Venous trophic ulcers are marked by a significant reduction of partial oxygen tension in the tissues adjacent to the area of trophic ulcers to 4.3±0.5 mm Hg on the average in the presence of the low functional microcirculatory reserve. Local tissue hypoxia in the area of trophic ulcers, which develops despite an increase of blood inflow to the inicrocirculatory bed evidences inhibition of tissue flow and activation of the arterio-venular bypasses.

The results obtained in the course of the study allow to optimize the treatment policy in elderly patients suffering from venous trophic ulcers.

In addition to the measures lowering venous hypertension, the treatment should include correction of microcirculatory disorders, which is to be carried out in the pre- and postoperative periods.

KEY WORDS: chronic venous insufficiency, venous trophic ulcer, laser Doppler flowmetry, percutaneous measurement of oxygen tension, microcirculatory disorders.

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