Metabolic activity of skeletal muscle in patients with peripheral arterial insufficiency. Effect of arterial reconstructive surgery.

The metabolic capacity of leg muscles was determined in 12 patients with peripheral arterial insufficiency before and 6 months after vascular surgery. Succinic oxidase activity and the incorporation rates of glucose-carbon into glycogen, lipids, lacate, and CO2 were determined as a measure of metabolic capacity. Leg muscles from patients with intermittent claudication had high metabolic capacity, as shown previously. This capacity was reduced towards control values after successful revascularizations, while it remained unchanged if the surgery failed. In patients with gangrene the preoperative values of leg muscles' metabolic capacity were subnormal, and increased towards control values if surgery was successful. In 2 patients with limb gangrene the vascular surgery was only partially successful i.e. the gangrene threat was changed into intermittent claudication. In these 2 patients the metabolic capacity of leg muscles changed from sub- to supracontrol values. In 2 patients the vascular surgery failed, and the patients had no benefit from the operation. In these 2 patients the metabolic capacity of leg muscles remained unchanged. These results support the theory that changes in the amount of blood flow, i.e. the supply of oxygen and substrates to the leg, govern the level of metabolic capacity of the skeletal muscles. The results seem to justify the recommendation that reconstructive arterial surgery in patients with intermittent claudication ought to be followed by physical training to preserve the high metabolic capacity in the skeletal muscles.