Microcirculatory Compensation to Progressive Atherosclerotic Disease

Cisek, Paul; Eze, Augustine R.; Comerota, Anthony J.; Kerr, Robb P.; Brake, Bonnie; Kelly, Patrick J.

doi:10.1007/s100169900009

Cited by 24 publications

(31 citation statements)

References 16 publications

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“…The claudication patients obviously had severe large vessel disease, but they maintained high cutaneous flow, greater than in the non-diabetic control subjects. In fact, our findings of decreased microcirculatory resistance in these patients correlate with the findings of others using different techniques [6]. Apparently, decreased large vessel perfusion pressure leads to compensatory vasodilation in the cutaneous microvasculature.…”

Section: Discussionsupporting

confidence: 91%

Cutaneous blood flow and peripheral resistance in type II diabetes as compared to intermittent claudication patients

Rendell¹,

Saxena²,

Shah³

2011

Int J Angiol

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Insulin deficient, type I diabetic patients have reduced skin blood flow reserve. It is not known whether these skin perfusion abnormalities also exist in non-insulin dependent (type II) diabetic patients. An additional open question is whether the reduced skin blood flow is due to increased resistance of the cutaneous microvasculature or to decreased peripheral perfusion pressure due to increased atherosclerosis in the diabetic population. We measured skin blood flow by laser Doppler flowmetry in patients with type II non-insulin treated diabetes. Limb systolic blood pressure was measured distally using a sensitive sonar Doppler device at the finger and toe. The ratio of pressure to flow was computed as an index of peripheral blood flow resistance. To assess the effect of cutaneous blood flow resistance, we elicited maximal vasodilation by increasing local skin temperature directly at the site of the laser Doppler probe. We compared blood flow and pressure in diabetic patients with the values in non-diabetic control patients. As a further control population, we also assessed these same parameters in non-diabetic patients with peripheral vascular disease, which may be expected to decrease large arterial blood flow pressure without directly affecting the microvasculature. There were 68 type II diabetic patients, 18 non-diabetic control subjects, and 25 non-diabetic patients with intermittent claudication. We measured skin blood flow at the dorsal surfaces of the finger and toe, sites with primarily nutritive capillary perfusion, and at the plantar surfaces of the finger and toe, where arteriovenous shunt perfusion predominates. Heat stimulated flow was markedly lower for the diabetic patients at the finger dorsal surface (16.5 ± 1.4 ml/min/ 100 g vs 29.8 ± 4.4 ml/min/100 g in the non-diabetic group (p < 0.05). The resistance index was 13.2 ± 1.9 in the diabetic patients and 6.8 ± 1.7 in the controls (p < 0.05). At the toe dorsum, basal temperature flow was significantly lower in the diabetic group (0.6 ± 0.1 ml/ min/100 g) than in the non diabetic group (1.1 ± 0.2 ml/ min/100 gm) with resistance index almost twice as high (379 ± 32) in the diabetic group versus non-diabetic controls (208 ± 36) [p < 0.01 for both comparisons]. With the local application of heat, there was a much larger increase in flow in the non-diabetic subjects than in the diabetic group. The resistance index dropped much more with heat stimulation for the non-diabetic patients (10.8 ± 3.3) than for the diabetic patients (50.6 ± 10.4) [p < 0.01] There was a lesser rise in flow at the toe pulp surface with heat in the diabetic patients (31.3 ± 3.0 ml/ min/199 gm) than in the control subjects (45.4 ± 5.9 ml/ min/100 gm; p < 0.05) with a higher resistance index (13 ± 4) than in the non-diabetic subjects (4 ± 1) [p < 0.05]. The claudication patients had substantially greater flow at the toe dorsal surface at basal temperature (2.2 ± 0.4 ml/min/100 gm) with significantly lower resistance index (126 ± 24) than the non-diabetic controls (p < 0.05). At ...

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Section: Discussionsupporting

confidence: 91%

Cutaneous blood flow and peripheral resistance in type II diabetes as compared to intermittent claudication patients

Rendell¹,

Saxena²,

Shah³

2011

Int J Angiol

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“…Previous studies have shown that the VAR in patients with peripheral arterial obstructive disease (PAD) is impaired, possibly as an adaptive response to a lower arterial perfusion and pressure. 9,11,13,14 Assuming that IPC produces blood flow increase by temporarily abolishing postural vasoconstriction, the effect of IPC might depend at least in part on the VAR. We hypothesized that the integrity of postural vasoregulation may correlate with blood flow augmentation on IPC application.…”

mentioning

confidence: 99%

Integrity of venoarteriolar reflex determines level of microvascular skin flow enhancement with intermittent pneumatic compression

Husmann

Willenberg

Keo

et al. 2008

Journal of Vascular Surgery

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“…Reports of the influence of microcirculatory alterations on macrocirculation are rare and inconsistent [7][8][9]. Yet, recent publication of HumeauHeurtier et al [10] described alterations in microvascular perfusion in PXE patients.…”

Section: Discussionmentioning

confidence: 99%

A Case of Pseudoxanthoma Elasticum with Microvascular Alterations: Possible Explanations and Causes

Stumpf¹,

Steinmetz²,

Skowasch³

et al. 2017

Orthop Muscular Syst

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Microcirculatory Compensation to Progressive Atherosclerotic Disease

Cited by 24 publications

References 16 publications

Cutaneous blood flow and peripheral resistance in type II diabetes as compared to intermittent claudication patients

Cutaneous blood flow and peripheral resistance in type II diabetes as compared to intermittent claudication patients

Integrity of venoarteriolar reflex determines level of microvascular skin flow enhancement with intermittent pneumatic compression

A Case of Pseudoxanthoma Elasticum with Microvascular Alterations: Possible Explanations and Causes

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