Effects of Percutaneous Transiuminal Angioplasty on Skin Microcirculation in Patients with Disabling Peripheral Arterial Occlusive Disease

Abstract

Percutaneous transiuminal angioplasty (PTA) provokes a huge trauma to the arterial wall and potentially liberates fragments of atherosclerotic material that may impair the microcirculation downstream. Incidence and clinical relevance of such embolisms are not known. This study was aimed at investigating the changes of the skin microcirculation in patients with peripheral arterial occlusive disease undergoing PTA of the lower limbs. Pedal transcutaneous oxygen tension (tcpO₂) and nailfold skin microcirculation were measured in 21 patients with disabling peripheral arterial occlusive disease before and after PTA. Sixteen matched patients undergoing arteriography alone were used as controls. The skin microcirculation was investigated at the nailfold of the great toe by the combination of laser Doppler fluxmetry and dynamic capillaroscopy. PTA was successful in all patients. The tcpO₂ decreased immediately after PTA (ΔtcpO₂ = -5 mm Hg; p < 0.004), whereas it tended to increase (ΔtcpO₂ = 1 mm Hg; NS) following arteriography as compared with baseline values. By contrast, blood flow increased in both groups, predominantly for the total circulation in the PTA group and for nutritional circulation (p < 0.0017) in the arteriography group, respectively. Consequently, the ‘nutritional index’, i.e., the index of nutritional versus total microcirculation, was decreased following PTA, particularly following mechanical recanalization (p < 0.02), but did not change in the controls. The changes of this ‘nutritional index’ and those of the tcpO₂ were positively correlated (r = 0.4, p = 0.023). The decrease of both the pedal tcpO₂ and the index of nutritional versus nonnutritional skin microcirculation and the lack of improvement of the reserve flow following PTA support the view that the procedure generates infraclinical microembolisms downstream in the microcirculation which may become of great clinical importance when PTA is performed in coronary arteries with compromised myocardium.

Capillaroscopy and the measurement of capillary pressure

“…In a further study the skin microcirculation was examined before and after treatment with either arteriography or percutaneous transluminal angioplasty (PTA) in matched groups of patients. Nutritional (capillary) flow was increased in the arteriography group but the increased blood flow in the PTA group was primarily non‐nutritive [103].…”

Transkutane Sauerstoffpartialdruckund Kohlendioxidpartialdruckmessung – Verfahrenstechnik- und Anwendungsgebiete

“…In älteren Untersuchungen an Patienten mit schwerer Ischämie zeigte sich unmittelbar nach Angioplastie ein Anstieg der tcpO 2 -Werte oberhalb des Malleolus lateralis (15), wohingegen in neueren Untersuchungen eine initiale Abnahme der tcpO 2 -Werte um 5 mmHg (Elektrodenheiztemperatur 44°C) nach Angioplastie registriert wurden (9). Ursächlich für den initialen verminderten nutritiven Blutfluss kommen Mikroembolien in Betracht, die während der Interventionen an den Gefäßen ausgelöst werden.…”

“…Ursächlich für den initialen verminderten nutritiven Blutfluss kommen Mikroembolien in Betracht, die während der Interventionen an den Gefäßen ausgelöst werden. Der Stellenwert der Mikroembolien wird als gering eingeschätzt, da nach spätestens einem Monat die nutritive Durchblutung signifikant ansteigt (9).…”