Intra-arterial thrombolytic therapy of ischaemic complications of lower-limb diabetic angiopathy

Belyaev A.N., Pavelkin A.G, Rodin A.N.

Department of General Surgery and Anesthesiology named after N.I. Atyasov Mordovian State University named after N.I. Ogarev, Saransk, Russia

Based on the parameters of haemostasis, free radical oxidation and endogenous intoxication the study was aimed at assessing efficacy of intra-arterial administration of urokinase medac in complicated forms of lower-limb diabetic angiopathy.

The authors assessed the outcomes of treating a total of 32 patients with complicated forms of lower-limb diabetic angiopathy on the background of basic therapy and 30 patients whose combined therapy included intra-arterial administration of the thrombolytic agent urokinase medac, also studying the indices of haemostasis, endogenous intoxication, free-radical oxidation and antioxidant defence.

At admission to hospital, patients were found to have shifts of the coagulogram towards hypercoagulation. The group of patients receiving intra-arterial administration of urokinase showed that the examined parameters on day 20 of treatment as compared with basic therapy alone increased: those of coagulability by 6% (p<0.05), activated partial thromboplastin time by 14% (p<0.01), thrombin time by 9.2% (p<0.01), antithrombin III by 7% (p<0.001). The fibrinogen level decreased by 9% (p<0.05), malonic dialdehyde concentration dropped by 30% (p<0.001), the concentrations of catalase and superoxide dismutase elevated by 55% (p<0.001) and 42%, respectively (p<0.05). The effective concentration of albumin by day 20 increased up to 42.03±0.36 g/L and was by 5% higher as compared with the basic therapy alone (p<0.005). The toxicity index fell to 0.04+0.1 which was by 50% less than after basic therapy.

Conclusion. Intra-arterial administration of urokinase medac in treatment of lower-limb diabetic angiopathy considerably normalizes elevated processes of coagulation, accompanied by decreased intensity of free-radical oxidation and followed by elevated concentration of the antioxidant protection enzymes and a decrease in the degree of endogenous intoxication.

KEY WORDS: diabetic angiopathy, urokinase, intra-arterial, haemostasis, endogenous intoxication, free radical oxidation.

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