ENDOTHELIAL DYSFUNCTION MEASURED IN THE LOWER EXTREMITIES OF PATIENTS WITH PERIPHERAL ARTERIAL DISEASE

Introduction. Earlier studies suggest that endothelial dysfunction (ED) is independent in the severity of peripheral arterial disease (PAD), when the former is measured by brachial artery flow-mediated dilation (BAFMD). Aims. The objective of this study was to use the measurement of the femoral artery flow-mediated dilation (FAFMD) to analyse ED in the lower extremities (LE) of patients with PAD, and to study its relation with BAFMD and the anklebrachial index (ABI). Patients and methods. We took two groups of subjects; A: healthy subjects with an ABI > 0.9 and < 30 years old (n = 32); B: patients with symptomatic PAD and an ABI < 0.9 (n = 33). The BAFMD and the FAFMD and ABI were determined in both LE. Twelve femorals were measured on two occasions to calculate the intra-observer coefficient of variation. Results. The coefficient of variation was 2.6%. In the patients, the ABI was 0.58+/-0.14 in the symptomatic extremity and 0.76+/-0.18 in the contralateral limb (p < 0.001). The FAFMD of the symptomatic limb was 0.66+/-3.4% versus 1.64+/-3.5% in the contralateral limb (p = 0.39). In healthy LE it was 4.53+/-2.3% versus 0.66% in healthy subjects (p < 0.001). The BAFMD was A: 10.04+/-4.07%; B: 5.18+/-4.8% (p = 0.001). The coefficient of correlation between BAFMD and FAFMD was 0.53 (p < 0.001), and between FAFMD and ABI it was found to be -0.07 (p = 0.5). Conclusions. FAFMD is a valid technique of a similar value to BAFMD for evaluating ED. FAFMD was lower in the patients. The similarity observed between limbs with different degrees of involvement and the null correlation with the ABI support the independence of ED in the severity of PAD.