Regional and systemic hemorheological disorders during feet diabetic gangrene

67Nugzar Pargalava, Maya Mantskava,
George Mchedlishvili.

N. Bochua Center of Angiology and Vascular Surgery, 1. Chachava St., 0159, Tbilisi, Georgia.
Microcirculation Research Center, I.Beritashvili Institure of Physiology, 14 Gotua St., 0160, Tbilisi, Georgia.


Abstract. We investigated the RBC aggregability in the patients with the foot diabetic gangrene in the venous blood samples taken from the damaged foot before its amputation, as well as from the cubital vein (the systemic circulation). The RBC aggregability was investigated with the “Georgian technique” that is sensitive and provided us with direct and quantitative data.we found that the RBC aggregability was higher by about 20%, in the blood flowing from the gangrenous tissue than in the systemic circulation.

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Therefore, the sources of the systemic hemorheological disorders were the primarily damaged tissues. Taking into account that the blood in uninterruptedly flowing and mixing together in the whole circulatory bed we conclude that in the systemic circulation a certain compensatory mechanism provide for a partial normalization of the blood rheological properties, since the RBC aggregability never reaches the level in the blood of the healthy people.[/su_animate]
Key words: Microvascular hemorheology, diabetic gangrene, RBC aggregation.

1.    Introduction

Availability of pronounced hemorheological disorders in the diabetic patients are well known since long ago and play a significant role in development of tissue damages that complicate development of the disease [1].  However some specific points related to the tissue damages during the diabetes mellitus have not been sufficiently understood. Such are, in particular, the loci of origination and of the subsequent spread of blood alterations over the patient’s circulatory bed during the foots diabetic gangrene. The aim of the present study was to prove, on the one hand, where is the source of the microcirculatory disorders (specifically of the high RBC intravascular aggregation) originated and primarily disturbing the microvascular flow. On the other hand, it was necessary to find what happens further with the disturbed rheological disorders in the blood during the uninterrupted blood circulation in the patients’ body.


2.    Methods

The present study was carried out in patients with foot diabetic gangrenes just before its surgical amputation. We investigated simultaneously the venous blood samples flowing from the gangrenous tissue to the systemic circulation and the systemically circulating blood, which was sampled from the cubital vein of the same patients. The RBC aggregability in the blood was investigated with the technique that has certain opportunities in comparison with the others [2]. This provided us with direct, quantitativeand reliable data about the quantitative relationships of the aggregated and non-aggregated erythrocytes, which remaind in the own plasma without addition of any anticoagulants.


3.    Results

The RBc aggregability in the systemically circulating blood of the diabetic patients was significantly higher, by mean of 46%, than in the healthy control probands. However, when we compared the RBC aggregability of the systemically circulating blood )sampled from the cubital vein) and in the blood flowing from damaged feet (just before the surgical procedure) in each case, we found regularly that the first was significantly higher, by mean of 18%, than in the same patients systemic circulation (Fig.1). This evidenced that the rheological disorders originated just in the damaged feet and they turned out decreased when the blood became circulationg systemically.


4.    Discussion

Convincing evidence has been steadily accumulated that the blood rheological disorders damaging the surrounding tissues represent themselves a contributing factor in the pathogenesis of complications of the diabetes mellitus. It is certainly the microcirculation, particularly the capillaries and the adjoining arterioles and venules, where the effects of blood rheological disorders are most pronounced. By analyzing the spread of the hemorheological disorders from the damaged foot to the whole body’s microcirculation, we found that the RBC aggregability, as the most significant feature of the hemorheological disorders in the microcirculation [3], was regularly found to be significantly higher in the venous blood flowing from the damaged foot compared to the systemic circulation. This evidenced that the hemorheological disorders originated just in the feet with the diabetic gangrenes, and then became steadily distributed over the body’s circulatory bed where it subjected to s certain decrease. i.e., comparison. But a part of the blood, which occurred repeatedly during circulation in the damaged foot’s circulatory bed, became again more pathologically altered, and so in, as we also found recently in the patients with the brain infarcts (to be published).



[1] C.Le Devehat, T. Khodabandlou and M. Vimeux. Impaired hemorheological properties in diabetic patients with lower limb arterial ischemia. Clin Hemorheol.Microcirc. 25 (2001), 43-48.
[2] G. Mchedlishvili, N. Beritashvili, D. Lominadze, B. Tsinamdzgvrishvili. Technique for direct and quantitative evaluation of erythrocyte aggregability in blood samples. Biorheology. 30, (1993), 153-161
[3] G. Mchedlishvili, R. Shakarishvili, N. Momtselidze, L. Gobejishvili, M. Aloeva, M.  Mantskava. Comparative values of erythrocyte aggregability versus other indices of hemorheological disorders in patients with ischemic  brain infarct. Clin. Hemorheol. and Microcirc. 22, (2000),  9-15.


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