Changes after arterial reconstruction in the forefoot local vasoconstrictor response to increased venous transmural pressure

Eickhoff, J. H.; Engell, H. C.

doi:10.1111/j.1365-2362.1982.tb02238.x

“…The normal vasoconstrictor response on rising from the supine to the sitting position is diminished in patients with mild arterial disease [1] and is either absent or there is a paradoxical rise in skin perfusion in CLI [2]. More recently, studies by Jacobs et al [3] using capillary microscopy and transcutaneous oximetry have shown that the microcirculation is severely compromised in CLI with a reduced capillary density and capillary dilation.…”

Section: Introductionmentioning

confidence: 96%

Altered small artery morphology and reactivity in critical limb ischaemia

Hillier¹,

Sayers²,

Watt³

et al. 1999

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Although the pathophysiology of critical limb ischaemia is poorly understood, there is evidence that the condition of the small arteries may determine the outcome of revascularization procedures. This study was designed to investigate the effects of critical limb ischaemia on the structure and function of the small arteries in the leg. Small arteries (<500 microm) from proximal (non-ischaemic) and distal (ischaemic) sites were obtained from patients undergoing bypass surgery for critical limb ischaemia and mounted in a myograph. Reactivity and morphological measurements were carried out and compared with controls. Control vessels from the thigh and calf showed no difference in media to lumen ratio. However, a comparison of ischaemic and non-ischaemic vessels from the patients with critical limb ischaemia showed significant thinning of the ischaemic vessel wall. Contraction studies using noradrenaline and angiotensin II revealed a significant decrease in the response of ischaemic vessels compared with the non-ischaemic vessels from the same patient. Moreover, these differences in reactivity were still apparent after the responses were corrected for wall thickness. Endothelial function assessed using the endothelium-dependent agonists acetylcholine and bradykinin showed a significantly impaired relaxation response to acetylcholine but not to bradykinin in the ischaemic vessels, and acetylcholine-induced relaxation was not improved after incubation with indomethacin. There was no change in the response to the endothelium-independent cAMP-mediated vasodilator iloprost but a significant impairment to sodium nitroprusside which acts via cGMP. These results suggest that small arteries in critical limb ischaemia are altered in both structure and function, with vessel wall thinning and impaired responses to acetylcholine and sodium nitroprusside.

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“…The normal vasoconstrictor response on rising from the supine to the sitting position is diminished in patients with mild arterial disease [1] and is either absent or there is a paradoxical rise in skin perfusion in CLI [2]. The normal vasoconstrictor response on rising from the supine to the sitting position is diminished in patients with mild arterial disease [1] and is either absent or there is a paradoxical rise in skin perfusion in CLI [2].…”

Section: Introductionmentioning

confidence: 99%

Altered small artery morphology and reactivity in critical limb ischaemia

Hillier

¹

,

Sayers

²

,

Watt

³

et al. 1999

View full text Add to dashboard Cite

Although the pathophysiology of critical limb ischaemia is poorly understood, there is evidence that the condition of the small arteries may determine the outcome of revascularization procedures. This study was designed to investigate the effects of critical limb ischaemia on the structure and function of the small arteries in the leg. Small arteries (<500 microm) from proximal (non-ischaemic) and distal (ischaemic) sites were obtained from patients undergoing bypass surgery for critical limb ischaemia and mounted in a myograph. Reactivity and morphological measurements were carried out and compared with controls. Control vessels from the thigh and calf showed no difference in media to lumen ratio. However, a comparison of ischaemic and non-ischaemic vessels from the patients with critical limb ischaemia showed significant thinning of the ischaemic vessel wall. Contraction studies using noradrenaline and angiotensin II revealed a significant decrease in the response of ischaemic vessels compared with the non-ischaemic vessels from the same patient. Moreover, these differences in reactivity were still apparent after the responses were corrected for wall thickness. Endothelial function assessed using the endothelium-dependent agonists acetylcholine and bradykinin showed a significantly impaired relaxation response to acetylcholine but not to bradykinin in the ischaemic vessels, and acetylcholine-induced relaxation was not improved after incubation with indomethacin. There was no change in the response to the endothelium-independent cAMP-mediated vasodilator iloprost but a significant impairment to sodium nitroprusside which acts via cGMP. These results suggest that small arteries in critical limb ischaemia are altered in both structure and function, with vessel wall thinning and impaired responses to acetylcholine and sodium nitroprusside.

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“…Autoregulation mechanisms do maintain a constant perfusion pressure in the limbs, although this mechanism fails in patients with severe PAD. An increase in the arteriovenous pressure gradient may cause an increase in microvascular permeability for fluids and proteins [5, 9] and inflammatory responses following revascularization, resulting in edema [10, 34]. However, the attribution of hyperemia is probably limited, as illustrated by the occurrence of only a small increase in limb volume following percutaneous revascularization because no lymphatics are damaged [35].…”

Section: Discussionmentioning

confidence: 99%

“…Also, edema is known to impair macrovascular and microvascular circulation [7]. The pathophysiology of postreconstruction edema is thought to be a combination of hyperemia [8][9][10][11], increased capillary permeability [7,12], and lymphatic [3,4,[13][14][15][16] and venous [4,17] disruption. Reperfusion of ischemic tissue leads to up-regulation of inflammatory processes as well [18,19].…”

Section: Introductionmentioning

confidence: 99%

Prospective Randomized Controlled Trial to Analyze the Effects of Intermittent Pneumatic Compression on Edema Following Autologous Femoropopliteal Bypass Surgery

Slaa

¹

,

Dolmans

²

,

Ho

³

et al. 2010

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BackgroundPatients who undergo autologous femoropopliteal bypass surgery develop postoperative edema in the revascularized leg. The effects of intermittent pneumatic compression (IPC) to treat and to prevent postreconstructive edema were examined in this study.MethodsIn a prospective randomized trial, patients were assigned to one of two groups. All patients suffered from peripheral arterial disease, and all were subjected to autologous femoropopliteal bypass reconstruction. Patients in group 1 used a compression stocking (CS) above the knee exerting 18 mmHg (class I) on the leg postoperatively for 1 week (day and night). Patients in group 2 used IPC on the foot postoperatively at night for 1 week. The lower leg circumference was measured preoperatively and at five postoperative time points. A multivariate analysis was done using a mixed model analysis of variance.ResultsA total of 57 patients were analyzed (CS 28; IPC 29). Indications for operation were severe claudication (CS 13; IPC 13), rest pain (10/5), or tissue loss (7/11). Revascularization was performed with either a supragenicular (CS 13; IPC10) or an infragenicular (CS 15; IPC 19) autologous bypass. Leg circumference increased on day 1 (CS/IPC): 0.4%/2.7%, day 4 (2.1%/6.1%), day 7 (2.5%/7.9%), day 14 (4.7%/7.3%), and day 90 (1.0%/3.3%) from baseline (preoperative situation). On days 1, 4, and 7 there was a significant difference in leg circumference between the two treatment groups.ConclusionsEdema following femoropopliteal bypass surgery occurs in all patients. For the prevention and treatment of that edema the use of a class I CS proved superior to treatment with IPC. The use of CS remains the recommended practice following femoropopliteal bypass surgery.

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Changes after arterial reconstruction in the forefoot local vasoconstrictor response to increased venous transmural pressure

Cited by 9 publications

References 14 publications

Altered small artery morphology and reactivity in critical limb ischaemia

Altered small artery morphology and reactivity in critical limb ischaemia

Altered small artery morphology and reactivity in critical limb ischaemia

Prospective Randomized Controlled Trial to Analyze the Effects of Intermittent Pneumatic Compression on Edema Following Autologous Femoropopliteal Bypass Surgery

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