Free Fatty Acid Metabolism of Leg Muscles during Exercise in Patients with Obliterative Iliac and Femoral Artery Disease before and after Reconstructive Surgery

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Abstract
The free fatty acid (FFA) uptake and oxidation and the carbohydrate substrate exchange of leg muscles were studied during exercise in 14 patients with occlusive disease of the iliac or femoral arteries before and 3-6 months after reconstructive vascular surgery and in 5 healthy subjects. 14C-labeled oleic acid was infused continuously at rest and during exercise at work loads of 150-400 kg-m/min. The arterial concentration of FFA was similar both at rest and during exercise in patients and controls. The patients showed a smaller increase in the fractional turnover of FFA during exercise. Leg uptake and release of FFA in terms of micromoles per liter plasma did not differ significantly either at rest or during exercise between patients and controls. FFA oxidation could not be measured at rest but exercise data showed a lower fractional oxidation of FFA (P < 0.001) in the patient group (53±6%) compared with the controls (84±2%). For the entire material, fractional oxidation of FFA showed a significant negative regression on the lactate/pyruvate ratio in femoral venous blood. The ventilatory respiratory quotient (RQ) and the leg muscle exchange of glucose and lactate in the patients exceeded that of the controls. When six patients were studied after reconstructive surgery, fractional oxidation of FFA had risen from a preoperative value of 47±8 to 90±10%, other data for leg muscle FFA metabolism being unchanged. It is concluded: (a) that substrate catabolism by the leg muscles during exercise in these patients proceeds in excess of the simultaneous capacity to oxidize acetyl-CoA in the tricarboxylic acid cycle, and (b) oxidation of FFA by contracting muscle is related to the muscle cell redox state.