Systemic white blood and endothelial cell response after revascularization of critical limb ischemia is only influenced in case of ischemic ulcers.
OBJECTIVE
The aim of this study was to study the inflammatory response to open revascularization of an ischemic leg in terms of activation of white blood cells (WBC), platelets and endothelial cells.


METHODS
prospective study.


METHODS
Venous samples from 21 patients suffering critical limb ischemia (CLI) were drawn before, and 4 weeks after (20 patients) revascularization. Total WBC, differentiated WBC, and platelets were counted. Expression of CD11b/CD18 on granulocytes and monocytes and CD41 on platelets was measured by flow cytometry. Soluble endothelial markers (sICAM-1, sVCAM-1, sE-selectin and sP-selectin) were analysed with ELISA.


RESULTS
WBC and granulocyte count decreased in the subgroup of patients with ulcer and gangrene but no change in activation of WBC was recorded. The endothelial marker sICAM-1 decreased while VCAM-1 increased following surgery, most evident in the subgroup with ulcers and gangrene.


CONCLUSIONS
This study shows that revascularization of CLI does not significantly influence the inflammatory response in patients with rest pain only, but a limited response of down regulation was found in the ulcer/gangrene patients probably as an effect of healing ulcers.
Danielsson
P
P
Department of Vascular Diseases, University Hospital MAS, Malmö, Sweden. Peter.Danielsson@skane.se
Truedsson
L
L
Norgren
L
L
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001792:Blood Platelets / Q000378:metabolism; D018845:CD11 Antigens / Q000096:biosynthesis; D018821:CD18 Antigens / Q000096:biosynthesis; D019040:E-Selectin / Q000097:blood; D042783:Endothelial Cells / Q000378:metabolism; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005434:Flow Cytometry; D005500:Follow-Up Studies; D005734:Gangrene / Q000097:blood / Q000601:surgery; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D007511:Ischemia / Q000097:blood / Q000601:surgery*; D007866:Leg / Q000098:blood supply* / Q000473:pathology; D007958:Leukocyte Count; D007962:Leukocytes / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000097:blood; D010146:Pain / Q000097:blood / Q000601:surgery; D015539:Platelet Activation; D040201:Platelet Membrane Glycoprotein IIb / Q000096:biosynthesis; D012146:Rest; D012883:Skin Ulcer / Q000097:blood / Q000601:surgery; D016896:Treatment Outcome; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood; D014656:Vascular Surgical Procedures
D015415:Biomarkers; D018845:CD11 Antigens; D018821:CD18 Antigens; D019040:E-Selectin; D019007:P-Selectin; D040201:Platelet Membrane Glycoprotein IIb; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1