The effect of lower limb revascularization on the global endothelial function and cardiovascular risk

Endothelial dysfunction is an important pathomechanism of atherosclerosis. Among other things, it may be responsible both for a late outcome of lower extremity revascularization and occurrence of cardiovascular events in this high risk patient population. There are some papers available which show that improvement in leg perfusion, both after percutaneous or surgical intervention, may improve endothelial function, as well as decrease cardiovascular event risk and prolong overall and amputation-free patient survival. The potential mechanisms responsible for such a favorable effect of lower limb revascularization are as follows: recommendation of pharmacotherapy according to the recent guidelines, making possible the performance of percutaneous coronary interventions, an increase in nitric oxide release from the vascular wall, a decrease in vascular peripheral resistance, an increase in physical activity, improvement in glucose control, a decrease in inflammatory process activity, and oxidative stress reduction. In conclusion, there is an increased amount of data showing that lower extremity revascularization has a favorable pleiotropic effect, which should encourage the recommendation of a wider use of percutaneous and surgical intervention in the vascular bed, depending on individual indications.