Methods: 40 patients with intermittent claudication (IC) and 40 healthy volunteers performed isometric ankle exercise or treadmill exercise to maximal walking distance (MWD). Lower limb pH was recorded during and for 1 hour after exercise. 7 patients with acute (ALI) and 24 patients with critical limb ischaemia (CLI) underwent lower limb anterior pH monitoring pre-and for 48 hours post lower limb surgical revascularisation. Platelet aggregation, markers of inflammation, endothelial and coagulation activation and urinary markers of renal tubular damage were assessed in all subjects. Results: There was a fall in intramuscular pH following both types of exercise in all test subjects. The magnitude of the changes was greatest in patients with IC. In patients with IC, treadmill exercise reduced platelet aggregation. This was accompanied by endothelial activation. Coagulation activation occurred in patients with IC following both forms of exercise. Baseline pH was lower in patients with ALI. Following surgical revascularisation, intra-muscular pH increased immediately in the patients with ALI. pH recovery was prolonged in patients with CLI. Coagulation activation and increased platelet aggregation were observed in the post-operative period. Conclusion: Platelet aggregation is reduced immediately following treadmill exercise to MWD. Surgical revascularisation resulted in a prothrombotic state despite the use of peri-operative heparin and aspirin. Intramuscular pH measurement may have a role in assessing the severity of exercise induced ischaemia. It is unlikely that peri-operative tissue pH monitoring will have a role in CLI. Further work focusing on patients with ALI is required.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:509146 |
| Date | January 2008 |
| Creators | Collins, Patrick William Hugh |
| Publisher | University of Aberdeen |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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