PERIPHERAL NEUROPATHY ASSOCIATED WITH ISCHEMIC VASCULAR-DISEASE OF THE LOWER-LIMBS

This paper deals with the possible identification of somatic and auton omic nerve damage in patients with peripheral obliterative arterial di sease (POAD) at different stages of the disease, with a well-reproduci ble technique like electroneurographic evaluation of nerve conduction. In 64 patients with intermittent claudication, 19 patients with pain at rest, and 7 patients with trophic ulcers, electroneurographic evalu ation of motor (tibial and peroneal) and sensory (superficial peroneal and sural) nerve conduction was performed. The median nerve (motor an d sensory) was used as control. A severe impairment of sural and super ficial peroneal nerve velocities was evident in many claudicant patien ts and in all patients with pain at rest and trophic ulcers, with a pr ogression in the conduction abnormalities in advanced stages of the di sease. Motor nerve conduction showed only minor reductions in patients with claudication and pain at rest, although some of them did show ve ry poor velocity values. In 21 patients with intermittent claudication and sensory nerve abnormalities, the autonomic fibers activity, evalu ated by the skin sympathetic response (SSR) test, was significantly de pressed, thus suggesting an involvement of the local autonomic system in the ischemic disease. A correlation exists between the severity of the somatic nerve damage and the stage of the vascular insufficiency. However, in the group of claudicant patients, the evidence of similar ischemic threshold (claudication distance) may be associated with a ma rked difference in the amount of somatic nerve damage, The somatic and autonomic nerve alterations may play a relevant role in the progressi on of the disease toward critical limb ischemia.