Ischemic polyneuropathy in patients with critical lower limb ischemia

Background. Polyneuropathy is one of the complications of critical limb ischemia. In 30% of patients with critical limb ischemia, polyneuropathy occurs solely as a result of chronic tissue ischemia and is termed "ischemic polyneuropathy." In the diagnosis of ischemic polyneuropathy, clinical assessment is paramount due to the limited information yield of electrophysiological examination methods. This necessitates the study of diagnostic features characterizing ischemic polyneuropathy.

Objective. To determine the clinical and instrumental characteristics of ischemic polyneuropathy in patients with critical limb ischemia.

Patients and methods. From October 2, 2023, to March 31, 2025, patients with critical limb ischemia hospitalized in the Emergency Vascular Surgery Department of the N.V. Sklifosovsky Research Institute for Emergency Medicine. Patients underwent neurological assessment, sural nerve stimulation electroneuromyography, and assessment using the Neuropathy Disability Score (modified), the Neuropathy Symptom Score, and the Douleur Neuropathique 4 to determine the type of pain.

Results. Ischemic polyneuropathy was detected in 69% (n=45/65) of patients with critical limb ischemia. In 71% (n=32/45), ischemic polyneuropathy was accompanied by neuropathic pain. The most common symptoms of ischemic polyneuropathy were decreased vibration sensitivity (82-89%) and absent Achilles reflex (82%). A comparative analysis of clinical and laboratory data revealed that patients with ischemic polyneuropathy were less likely to have undergone coronary artery bypass grafting in the past, and the proportion of those taking atorvastatin and an antiplatelet agent in patients with ischemic polyneuropathy was lower (0/45 vs. 10 (2/20) (p=0.031); 13 (6/45) vs. 35 (7/20) (p=0.044); 13 (6/45) vs. 35 (7/20) (p=0.044), respectively).

Conclusions. Pain associated with critical limb ischemia may be caused by ischemic polyneuropathy. The most common symptoms of ischemic polyneuropathy are neuropathic pain, impaired vibration sensation, and absent Achilles reflex. The absence of HMG-CoA reductase inhibitors, antiplatelet therapy, and the absence of a history of coronary artery bypass grafting are associated with ischemic polyneuropathy in patients with critical lower limb ischemia.

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