Microdialysis assessment of peripheral metabolism in critical limb ischemia after endovascular revascularization

Ten patients diagnosed with critical limb ischemia was enrolled. CMA 60 (CMA？ - Solna, Sweden) catheter with a 20 kDa cut-off was placed subcutaneously on the anterior aspect of the foot of both limbs. Samples were collected starting 12-hours before surgery and throughout the following 72-hours, using a CMA 600 (CMA？ - Solna, Sweden) microdialysis analyser.Technical revascularization was successful in all cases. The cannulation was well tolerated in all patients. The site of catheter insertion healed easily in few days without infective complications in any case. Two patients underwent major amputation. After revascularization, glucose showed a strong increase (mean, 5.86 ± 1.52 mMol/L, p = .008). No restoration of the circadian rhythm was noted in patients who underwent major amputation. Glycerol concentration curves were not deductibles in both the ischemic and the control limbs (mean, 148.43 ± 42.13 mMol/L vs 178.44 ± 75.93 mMol/L, p = .348). Within the first 24-hours after revascularization, lactate concentration raised strongly (6.58 ± 1.56 mMol/L, p = .002): thereafter, it immediately decreased to a concentration similar to the control level (1.71 ± 1.69 mMol/L). In both patients who underwent major amputation, lactate did not show the typical peak of the successful revascularization. The trend of the lactate/pyruvate ratio after a brief initial decrease of the ratio increased again in both the patients who finally underwent amputation.Restoration of glucose and glycerol circadian rhythm, coupled with low lactate concentration and lactate/pyruvate ratio seemed to be linked to good surgical outcome.Critical limb ischemia (CLI) has been recently re-defined by the Trans-Atlantic Inter-Society Consensus (TASC II) document [1,2]. Contemporarily, a vivid interest has grown on the attempt to identify biologic markers to be coupled to the usual criteria (clinical, hemodynamic, radiologic) used for diagnosis, treatment and follow-up evaluation of CLI [3].Microdialysis