In critical limb ischaemia (CLI), the ability to regulate regional blood flow in the diseased portion of the leg would appear to be severely compromised. Considering this, pressure-dependent myogenic and mechanical properties of resistance arterioles isolated from control subjects and from patients with CLI were studied. Using confocal microscopy and pressure myography, subcutaneous resistance arteriole structure and function were compared between subcutaneous arterioles isolated from healthy volunteers [control subcutaneous (CS)] and non-diseased proximal subcutaneous (PS; internal control) and distal subcutaneous (DS) arterioles from the diseased ischaemic part of the limb from patients with CLI. Significant wall atrophy was observed in DS arterioles compared with PS and CS arterioles. Passive pressure-dependent mechanical properties were significantly altered in the diseased arterioles compared with PS and CS arterioles. Active pressure-dependent myogenic tone was completely absent in DS arterioles. The atrophic structural remodelling in DS arterioles were correlated with the changes in vascular mechanics, but not with the ability of these arterioles to contract in response to chemical stimuli. However, active pressure-dependent myogenic tone was absent in the DS arterioles. The combination of altered pressure-dependent passive mechanical and active myogenic tone goes some way in explaining CLI sequelae and poor outcome following surgical revascularization experienced by these patients.

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