[Promising methods of studying perfusion in patients with atherosclerosis of peripheral arteries]. / Perspektivnye metody issledovaniia perfuzii u patsientov s aterosklerozom perifericheskikh arterii.

ABSTRACT

Prevalence of atherosclerotic peripheral artery disease (PAD) has steadily been increasing all over the world, affecting approximately 10% of the population. PAD dramatically decreases the patients' quality of life and is accompanied by high risks of limb amputation and death. Reconstructive and restorative interventions make it possible to achieve the highest success in treatment of PAD. Their results largely depend on the state of the patient's peripheral bed. Currently, the periphery is objectively assessed by means of ultrasonographic duplex examination, digital subtraction angiography, roentgen computed tomographic angiography (CTA), and in a series of cases magnetic resonance tomographic angiography (MRA). Widely known are the scale of assessing peripheral vascular resistance, suggested by R. Rutherford and the Bollinger scoring system. All these methods study predominantly the major blood flow, only slightly touching the microcirculatory bed. Promising methods in this area are radionuclide methods - single-photon emission computed tomography (SPECT) and positron-emission tomography (PET). Used singly, they possess high sensitivity but low spatial resolution, therefore they are supplemented by CTA or MRA. It is supposed that the use of radionuclide methods would make it possible to accurately assess the state of an atherosclerotic plaque and angiogenesis in conditions of ischaemia. Yet another method of diagnosis of microperfusion is contrast-enhanced ultrasonography (CEUS). CEUS reveals deficit of perfusion of the gastrocnemius muscles of patients with PAD in accordance with severity of the disease and degree of the development of collaterals. It is also used for determining the results of therapy with agents improving microcirculation. The degree of blood supply to tissues may be evaluated with the help of perfusion computed tomography (PCT). The main area of its application is diagnosis of impairments of cerebral circulation. Under study is a possibility of using PCT in atherosclerosis of lower-limb arteries, as well as assessing the efficacy of the reconstructive and restorative procedures performed.