title: Effects of lower extremity revascularization on the endothelial functions measured with noninvasive brachial artery flow-mediated dilatation.
abstract: BACKGROUND
  Endothelial function is best measured with the noninvasive brachial artery flow-mediated dilatation (FMD) method. Peripheral arterial diseases and systemic cardiovascular diseases have FMD-lowering effect. The effects of lower extremity ischemia are associated with muscle inflammation and claudication, which may further lead to arterial stress. Our aim in this study was to investigate the effects of peripheral arterial revascularization on the endothelial functions through noninvasive brachial artery FMD.
  
  
  METHODS
  Between January 2007 and February 2008, 54 patients diagnosed with lower extremity arterial disease undergoing revascularization were included in the study. Endothelial function is measured preoperatively and at the fourth week postoperatively using the brachial artery FMD method. Blood samples were collected at the same intervals for the measurement of interleukin-6, leukocyte count, tumor necrosis factor-alpha, and nitric oxide values.
  
  
  RESULTS
  Femoropopliteal bypass grafting was performed in all patients with a synthetic graft. The mean ankle-brachial index in the preoperative period was 0.29 ± 0.083, and after the operation, dorsalis pedis and/or posterior tibial artery became palpable in all patients. The nitric oxide, interleukin-6, high-sensitivity C-reactive protein, and tumor necrosis factor-alpha levels decreased significantly after 4 weeks postoperatively as compared with the preoperative levels (p < 0.05). Postoperative Doppler ultrasonography FMD of brachial artery increased from preoperative value of 9.2 ± 2.1 to 16.2 ± 4.5 (p < 0.01) at postoperative week 4.
  
  
  CONCLUSIONS
  Systemic inflammation and muscle ischemia lead to reduced endothelial functions. After successful lower extremity revascularization, endothelial functions improve dramatically, which may be easily detected with the noninvasive brachial artery FMD method.
authors.affiliation: Department of Vascular Surgery, Okmeydani Training Hospital, Istanbul, Turkey.
authors.forename: Orcun
authors.initials: O
authors.lastname: Unal
authors.forename: Oguzhan
authors.initials: O
authors.lastname: Karatepe
authors.forename: Murat
authors.initials: M
authors.lastname: Ugurlucan
authors.forename: Bora
authors.initials: B
authors.lastname: Koc
authors.forename: Ugur
authors.initials: U
authors.lastname: Filizcan
authors.forename: Murat
authors.initials: M
authors.lastname: Aksoy
mesh_terms: D000328:Adult; D055109:Ankle Brachial Index; D001157:Arterial Occlusive Diseases / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D019917:Blood Vessel Prosthesis Implantation; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002097:C-Reactive Protein / Q000378:metabolism; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007958:Leukocyte Count; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012039:Regional Blood Flow; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D014421:Turkey; D018608:Ultrasonography, Doppler; D014664:Vasodilation
chemical_list: D015415:Biomarkers; C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D009569:Nitric Oxide; D002097:C-Reactive Protein