THE CONCENTRATION OF HIGH-MOLECULAR-WEIGHT COMPOUNDS IN INTERSTITIAL-TISSUE FLUID - A STUDY IN PATIENTS WITH POST-RECONSTRUCTIVE LEG EDEMA

Objectives: To study whether relative changes in the concentration of different proteins of the subcutaneous interstitial tissue fluid in pa tients with postreconstructive leg oedema could give information on th e integrity of the capillary wall following vascular reconstruction. M aterials: Sixteen patients developed ipsilateral leg oedema following femoropopliteal (n=14) or femorotibial (n=2) bypass surgery for interm ittent claudication (n=10) or critical lower limb ischaemia (n=6) caus ed by obliterating atherosclerosis. Methods: The leg volume increase w as measured according to the formula of a truncated cone. The blister suction method was used for sampling of subcutaneous interstitial tiss ue fluid. The concentration of albumin, transferrin, immunoglobulin G and alpha(2)-macroglobulin of serum and blister fluid was measured wit h nephelometry. Results: Seven days postoperatively the mean leg volum e increase was 32% (19.8%) in the operated leg compared to the contral ateral side (p<0.01). In the blister fluid each of the proteins had a significantly higher concentration in the operated leg compared to the control leg. This concentration difference was relatively larger for the proteins with the highest molecular weight, immunoglobulin G (p=0. 006) and alpha(2)-macroglobulin (p=0.002). Conclusions: A relatively l arger concentration difference of the bigger molecules in the subcutan eous interstitial tissue fluid in patients with post-reconstructive le g oedema suggests increased capillary permeability to plasma proteins following vascular reconstruction.