The measurement of the blood flow through skeletal muscle from the local clearance of 133-xenon

Bell, Graham (1971) The measurement of the blood flow through skeletal muscle from the local clearance of 133-xenon. Ch.M thesis, University of Glasgow.

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Abstract

A technique for the measurement of the blood flow through skeletal muscle, from the local clearance of the radio-active inert gas 133xenon, has been described. The muscle blood flow estimations had a mean coefficient of variation of 10 per cent over time intervals up to 3 months and from this it was concluded that the technique would be of value for long-term studies. In a group of 58 normal subjects, the mean resting blood flow was 2.28 ml/100 gm./min. (S.D. +/- 0.92). Muscle blood flow was studied following ischaemic exercise and the mean peak blood flow was 62.0 ml./100 gm./min. (S.D. +/- 17.7), mean time to peak blood flow was 0.46 min, (S.D. +/- 0.37), and mean duration of peak blood flow was 1.08 min. (S.D. +/- 0,21). In this normal group, it was found that the peak muscle blood flow was significantly reduced in the over 40-60 and over 60 age groups. A group of 109 patients (177 limbs) suffering from atherosclerotic peripheral arterial disease have been studied. There was no difference between resting blood flow in this group and that in the normal group. Following ischaemic exercise, the mean peak blood flow was 29.3 ml./l00 gm./min. (S.D. +/- 12.0), time taken to achieve peak blood flow was 1.67 min. (S.D. +/- 1.0) and duration of peak blood flow 2.41 (S.D. +/- 1.27). These changes were statistically significant (p < 0.001 in all cases). Thus, the typical finding in patients suffering from peripheral arterial disease is a reduction in the level of peak blood flow, a delay in reaching the level of peak blood flow and a prolongation of the peak blood flow. These changes were found to be greatest in patients with occlusive lesions distal to the inguinal ligament and least in patients with generalised disease without main vessel occlusion: those patients who had occlusive lesions proximal to the inguinal ligament lay somewhere in between. The technique has been used in the study of patients who had direct arterial surgery for atherosclerosis of the peripheral vessels. Seventy-six patients have been studied before and after surgery. These were subdivided into patients having surgery to the aorto-iliac region (either thrombo-endarterectomy or replacement graft) and surgery to the femoro-popliteal region (either thrombo- endarterectomy or bypass vein graft), In all these groups, there was good correlation between the muscle blood flow results and the success or failure of the surgical procedure and the blood flow results provided objective evidence of the result. It was also found that, following successful surgery, the muscle blood flow may revert to a normal pattern. In the aorto-iliac thrombo-endarterectomy group, the results were seriously impaired if there was a distal occlusive lesion present in addition to the proximal lesion. In the group studied, only 31 per cent of the patients with an additional distal occlusion showed an improvement in peak muscle blood flow and relief in claudication compared to 61 per cent in the group as a whole. In the different groups studied, there were cases where the patient claimed relief of claudication yet the patient showed no improvement in peak muscle blood flow. The time taken to reach peak blood flow following release of the occluding cuff was reduced in some instances, however. Thus, this reduction in time to achieve peak blood flow appeared to be sufficient to improve the symptom of intermittent claudication. In other cases, arteriography was carried out and this confirmed that the operated segment had undergone occlusion; the muscle blood flow measurements therefore may be of value in selecting those patients who should have post-operative arteriography. In the first post-operative year, peak muscle blood flow studies were carried out at 3 months, 6 months and 1 year in all groups. In most cases the improvement in peak muscle blood flow was well maintained during this period. However, in 50 per cent of the patients having thrombo-endarterectomy to the femoral and popliteal arteries, there was a gradual return towards the pre-operative level following an initial improvement. This suggests that these patients should have continued long-term follow-up as they appear to be at risk of late failure. In 50 patients (51 limbs), a study has been made of muscle blood flow before and after lumbar sympathectomy. There was no change in resting blood flow, peak blood flow, time to achieve peak blood flow or duration of peak blood flow following operation. 21.1 per cent of patients claimed improvement in the symptom of intermittent claudication when followed up over the first post-operative year. Peak muscle blood flow in the non-operated limb showed a gradual increase in 20 per cent of cases over a similar period of time. It has been concluded that the improvement in intermittent claudication occasionally found following lumbar sympathectomy is due to the opening up of the collateral circulation rather than to the operation itself.

Item Type: Thesis (Ch.M)
Qualification Level: Masters
Additional Information: Adviser: Arthur W Mackey
Keywords: Medicine, Physiology
Date of Award: 1971
Depositing User: Enlighten Team
Unique ID: glathesis:1971-74150
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 23 Sep 2019 15:33
Last Modified: 23 Sep 2019 15:33
URI: http://theses.gla.ac.uk/id/eprint/74150

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