Intermittent compression induces transitory hypoxic stimuli, upstream vasodilation and enhanced perfusion of skin capillaries, independent of age and diabetes

Abstract

The benefit of enhanced shear stress to the vascular endothelium has been well documented in conduit arteries but is less well understood in skin microcirculation. The study aim was to provide physiological evidence of the vascular changes in skin microcirculation induced by intermittent pneumatic compression (IPC) of 1 second cuff inflation (130 mmHg) every 20 seconds to the palm of the hand for 30 minutes. The oxygenation and hemodynamics of dorsal mid-phalangeal finger skin microcirculation were assessed by laser Doppler fluximetry and reflectance spectroscopy before, during and after IPC in 15 young (18-39 years) and 39 older (40-80 years) controls and 32 older subjects with type 2 diabetes mellitus. Each individual cuff inflation induced: 1) brief surge in flux immediately after cuff deflation followed by 2) transitory reduction in blood oxygen for ~4 second and 3) a second increase in perfusion and oxygenation of the microcirculation peaking ~11 seconds after cuff deflation in all subject groups. With no significant change in blood volume observed by reflectance spectroscopy, despite the increased shear stress at the observed site this second peak in flux and blood oxygen suggests a delayed vasoactive response upstream inducing increased arterial influx in the microcirculation which was higher in older controls and subjects with diabetes compared to young controls (p<0.001, p<0.001 respectively) and achieving maximum capillary recruitment in all subject groups. Transitory hypoxic stimuli with conducted vasodilation may be a mechanism through which IPC enhances capillary perfusion in skin microcirculation independent of age and type 2 diabetes mellitus.

Pneumatic Compression versus Local High-Frequency Vibration Impact on Nerve Conduction and Balance Performance in Diabetic Polyneuropathy

“…This increases blood flow and vascular function, due to active vasodilatation and hyperemic reactions. The results are consistent with the results of Thorn et al [17] that insisted on the positive effect of hand intermittent pneumatic compression evoking transitory hypoxic stimuli in distal finger skin microcirculation inducing vasodilation of arterial inflow vessels, in young and older subjects and older subjects with type 2 diabetes mellitus. Winberg et al [18] confirmed our findings that intermittent pneumatic compression may be a plausible treatment modality for improving self-reported foot sensation as well as static and dynamic balance control, raising NCV as a sign of improvement.…”

Effects of Intermittent Pneumatic Compression on Lower Limb Lymphedema in Patients with Type 2 Diabetes Mellitus: A Pilot Randomized Controlled Trial

“…In 2012, Palazzin et al reported that MLD of lower limbs led to a reduction in blood and urinary glucose in patients affected by type 1 diabetes mellitus [ 37 ]. Recently, in 2021, Thorn et al [ 38 ] demonstrated that IPC of an upper limb induced arterial inflow vessels vasodilation with enhanced perfusion and determined the maximum capillary recruitment in subjects suffering from T2DM. Moreover, Nikolovska et al showed that this tool speeds up lymphatic drainage and disposal of metabolic products [ 39 ].…”