A systematic evaluation of cutaneous microcirculation in the foot using post‐occlusive reactive hyperemia

Balasubramanian, Gayathri; Chockalingam, Nachiappan; Naemi, Roozbeh

doi:10.1111/micc.12692

Cited by 9 publications

(13 citation statements)

References 34 publications

(121 reference statements)

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“…Furthermore, prolonged ischemia can lead to endothelial dysfunction and disruption of endothelial cell boundaries, causing a bleeding event [13]. Finally, a sudden increase in renal venous pressure due to post-occlusive reactive hyperemia can result in renal rupture [3,14]. As underlined by the histopathological report, the presented vascular lesions in the kidney of our patient could have triggered some of the aforementioned ischemia-related mechanisms causing SRR.…”

Section: Discussionmentioning

confidence: 63%

Retroperitoneal Hemorrhage Due to Spontaneous Renal Rupture as the First Presentation of Antiphospholipid Syndrome: A Case Report

Mavridis¹,

Lagoudaki²,

Georgiadis³

et al. 2023

Cureus

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Spontaneous renal rupture (SRR) with retroperitoneal hemorrhage is an extremely rare medical emergency and is rather challenging for the surgical team. Management of SRR often requires surgical intervention and nephrectomy as it is life-threatening. Antiphospholipid syndrome (APLS) is an autoimmune disease that affects several organs, including kidneys, causing significant abnormalities. Current data suggest that APLS can result in renal artery stenosis, renal vein thrombosis, arterial hypertension, thrombotic microangiopathy, and antiphospholipid syndrome nephropathy where there is renal involvement. Here, we report the case of a 49-year-old man who presented to the Emergency Department with sudden-onset abdominal pain in the context of retroperitoneal bleeding due to SRR. The patient developed hemodynamic instability and underwent a total nephrectomy. The surgical specimen revealed APLS-related lesions. Serological tests confirmed the diagnosis of APLS, which was managed with acenocoumarol and hydroxychloroquine. Since then, he has not experienced any thromboembolic or hemorrhagic episodes. This article aims to present for the first time a case of SRR as the first presentation of APLS as well as to analyze the possible associated mechanisms.

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Section: Discussionmentioning

confidence: 63%

Retroperitoneal Hemorrhage Due to Spontaneous Renal Rupture as the First Presentation of Antiphospholipid Syndrome: A Case Report

Mavridis¹,

Lagoudaki²,

Georgiadis³

et al. 2023

Cureus

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“…Postocclusive reactive hyperemia is a common method to assess peripheral vascular function in people with diabetes [ 42 , 43 ] and estimate therapeutic effect [ 44 ]. By drawing on this inflation-compression model, this experiment applied compression with 150 mmHg for 15 min to subjects' whole foot and measured microvascular responses under vibration/nonvibration to explore whether vibration could alleviate pressure-induced ischemia.…”

Section: Discussionmentioning

confidence: 99%

Effect of Vibration on Alleviating Foot Pressure-Induced Ischemia under Occlusive Compression

Ren

Zhang

Liu

et al. 2021

Journal of Healthcare Engineering

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Objectives. Foot ulcers often occur in people with diabetes because of pressure-induced tissue ischemia. Vibration has been reported to be helpful in alleviating mechanical damage and promoting wound healing. The objective of this study is to explore whether vibration can relieve reactive hyperemia in foot tissue under occlusive compression. Methods. Thirteen healthy adults participated in the study. Each foot was placed under occlusive compression without or with vibration intervention, which was randomly assigned every other day. The dorsal foot skin blood flow (SBF) was measured pre- and postintervention for each subject in each test. Temporal variations and spectral features of SBF were recorded for comparison. Results. The results showed that subjects displayed an obvious reactive hyperemia in the foot tissue after pressure occlusion, whereas they displayed a more regular SBF when vibration was applied along with occlusive compression. Moreover, the amplitude of metabolic, neurogenic, and myogenic pathways for SBF was significantly reduced during the hyperemia process when vibration was applied. Conclusions. This study demonstrated that vibration can effectively reduce the level of hyperemia in foot tissue under occlusive compression and also induce less protective physiological regulatory activities. This is helpful for protecting foot tissue from pressure-induced ischemic injury and foot ulcers.

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“…The foot will experience pressure magnitudes much larger, thus hypoxia in the foot sole skin is habitual and frequent, yet healthy feet do not ulcerate. In healthy skin, the microvasculature has a protective stress response known as post-occlusive reactive hyperemia (PORH) which is characterized by a large influx of capillary blood flow (vasodilation) upon the release of an occlusion ( Johnson et al, 2014 ; Balasubramanian et al, 2021 ). This reactive mechanism is imperative to counteract the ischemic deficit and flush the hypoxic tissue with oxygen and nutrients.…”

Section: Introductionmentioning

confidence: 99%

“…The pathogenesis of diabetic neuropathy is not fully understood, however, there is some evidence that the sensory end organs (mechanoreceptor) are damaged prior to any changes to axonal transduction ( Mizobuchi et al, 2002 ). In addition to decreased sensation, individuals with diabetes also tend to have poor peripheral circulation and oxygenation of skin tissue ( Jorneskog et al, 1995 ; Zimny et al, 2001 ; Petrofsky, 2012 ; Jan et al, 2013 ), which impairs skin healing ( Shapiro and Nouvong, 2011 ; Balasubramanian et al, 2021 ) and further contributes to ulceration risk ( Singh et al, 2005 ; Lim et al, 2017 ). PORH responses also are blunted in diabetic individuals ( Petrofsky et al, 2009 ; Barwick et al, 2016 ; Lanting et al, 2017 ), decreasing protective stress responses against tissue loading.…”

Section: Introductionmentioning

confidence: 99%

Mechanoreceptor sensory feedback is impaired by pressure induced cutaneous ischemia on the human foot sole and can predict cutaneous microvascular reactivity

Howe,

Apollinaro,

Bent

2024

Front. Neurosci.

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IntroductionThe foot sole endures high magnitudes of pressure for sustained periods which results in transient but habitual cutaneous ischemia. Upon unloading, microvascular reactivity in cutaneous capillaries generates an influx of blood flow (PORH: post-occlusive reactive hyperemia). Whether pressure induced cutaneous ischemia from loading the foot sole impacts mechanoreceptor sensitivity remains unknown.MethodsPressure induced ischemia was attained using a custom-built-loading device that applied load to the whole right foot sole at 2 magnitudes (15 or 50% body weight), for 2 durations (2 or 10 minutes) in thirteen seated participants. Mechanoreceptor sensitivity was assessed using Semmes-Weinstein monofilaments over the third metatarsal (3MT), medial arch (MA), and heel. Perceptual thresholds (PT) were determined for each site prior to loading and then applied repeatedly to a metronome to establish the time course to return to PT upon unload, defined as PT recovery time. Microvascular flux was recorded from an in-line laser speckle contrast imager (FLPI-2, Moor Instruments Inc.) to establish PORH peak and recovery rates at each site.ResultsPT recovery and PORH recovery rate were most influenced at the heel and by load duration rather than load magnitude. PT recovery time at the heel was significantly longer with 10 minutes of loading, regardless of magnitude. Heel PORH recovery rate was significantly slower with 10minutes of loading. The 3MT PT recovery time was only longer after 10 minutes of loading at 50% body weight. Microvascular reactivity or sensitivity was not influenced with loading at the MA. A simple linear regression found that PORH recovery rate could predict PT recovery time at the heel (R2=0.184, p<0.001).ConclusionIn populations with degraded sensory feedback, such as diabetic neuropathy, the risk for ulcer development is heightened. Our work demonstrated that prolonged loading in healthy individuals can impair skin sensitivity, which highlights the risks of prolonged loading and is likely exacerbated in diabetes. Understanding the direct association between sensory function and microvascular reactivity in age and diabetes related nerve damage, could help detect early progressions of neuropathy and mitigate ulcer development.

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A systematic evaluation of cutaneous microcirculation in the foot using post‐occlusive reactive hyperemia

Abstract: ThisisanopenaccessarticleunderthetermsoftheCreativeCommonsAttributionLicense,whichpermitsuse,distributionandreproductioninanymedium, provided the original work is properly cited. ©2021TheAuthors.MicrocirculationpublishedbyJohnWiley&SonsLtd.

Cited by 9 publications

References 34 publications

Retroperitoneal Hemorrhage Due to Spontaneous Renal Rupture as the First Presentation of Antiphospholipid Syndrome: A Case Report

Retroperitoneal Hemorrhage Due to Spontaneous Renal Rupture as the First Presentation of Antiphospholipid Syndrome: A Case Report

Effect of Vibration on Alleviating Foot Pressure-Induced Ischemia under Occlusive Compression

Mechanoreceptor sensory feedback is impaired by pressure induced cutaneous ischemia on the human foot sole and can predict cutaneous microvascular reactivity

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