Peripheral neuropathy in critical limb ischemia
M.N. Kudykin, G.E. Sheiko, A.N. Belova

Volga Research Medical University, Nizhny Novgorod

Critical limb ischemia (CLI) is an actual problem of modern medicine due to the increasing incidence, severity of outcomes and the presence of comorbidities. At the present moment, the features of the development of peripheral neuropathy (PN) in patients with CLI remain poorly studied, the contribution of chronic ischemia to the development of PN is not determined.
Aim: to study the frequency and nature of a lesion of peripheral nerve trunks in patients with critical limb ischemia, and to evaluate the role of ischemia in the development of peripheral neuropathy in patients with critical ischemia.
Patients and Methods: the study included 36 patients with the popliteal-tibial artery segment occlusion of the lower extremity (type D according to TASC II classification) in the stage of critical ischemia to assess the nature and frequency of PN. The average age of patients was 62±7.8 years. Patients were divided into two groups depending on the presence of type 2 diabetes mellitus (DM2) to assess the role of ischemia in the development of PN. Group 1 — 10 (28%) patients without DM2, group 2 — 26 (72%) with DM2. Subjective and clinical signs of PN were evaluated in all patients, and electroneuromyography (ENMG) of the tibial and peroneal nerves was also performed.
Results: peripheral nerve trunks lesion of the tibia was detected in 100% of patients with CLI. Disfunction was detected by at least one nerve of the tibia and was characterized by both clinical symptoms and a decrease in the nerve conduction velocity along the motor fibers of the affected nerve. The clinical symptoms and results of ENMG in groups with and without DM2 did not statistically significantly differ (p>0.05), which may indicate the leading role of ischemia in the development of peripheral nerve trunks lesions of the tibia.
Conclusion: PN predominantly of demyelinating character is an obligate manifestation of CLI. Ischemia plays a key role in the development of PN in patients with CLI.

Key words: critical limb ischemia, peripheral neuropathy, obliterating atherosclerosis of the lower extremities vessels, electroneuromyography, diabetes mellitus.
For citation: Kudykin M.N., Sheiko G.E., Belova A.N. Peripheral neuropathy in critical limb ischemia // RMJ. 2018. № 6(II). P. 70–73.