Study of Dynamic Microcirculatory Problems in 'Blackfoot Disease' - Emphasizing Its Differences from Arteriosclerosis

Abstract

The cutaneous microcirculation can be divided into thermoregulatory shunt vessels and nutritive skin capillaries. Flux in nonnutritional shunt vessels dominates the signal recorded by the laser Doppler flowmeter. Computerized videophotometric capillaroscopy is a sensitive method for assessing cutaneous nutritive microcirculation. Using patients with blackfoot disease and arteriosclerosis as disease models, we evaluated the sensitivity and clinical usefulness of these relatively new techniques for peripheral vascular disorders. In blackfoot disease, blood flux measured by the laser Doppler flowmeter in the affected toe was lower than that in the nonaffected toe. In symptom-free fingers, blood flow was not significantly different between blackfoot disease and arteriosclerosis. However, blood flow in both diseases was lower than that of the control group. Patients who had the same status of thermoregulatory flow and eyeground arteriosclerotic classification underwent a 1-min arterial occlusion of the digits. The postocclusive reactive hyperemia response (PRH) of nailfold capillary loops was evaluated. All parameters for PRH for the cutaneous nutrient microcirculation including resting capillary blood cell velocity (rCBV), peak capillary blood cell velocity (pCBV) and time to pCBV were more significantly disturbed in the blackfoot disease group than in the arteriosclerotic group. On the basis of the results of this study, dynamic capillaroscopy provides a new approach for the early detection of circulatory disturbances resulting from different mechanisms.

Peripheral Vascular Diseases Resulting from Chronic Arsenical Poisoning

“…In the early stages of blackfoot disease, the affected toes and fingers revealed an increased number of dilated tortuous nailfold capillary loops (Fig 3). In contrast, morphologic analysis of the capillary loops of the nonaffected toes and fingers showed no significant differences from those of normal controls (42,43). The parameters for the cutaneous microcirculation including resting capillary blood cell velocity, peak capillary blood cell velocity, and time to peak capillary blood cell velocity were significantly disturbed in both the affected and nonaffected toes and fingers in the blackfoot disease patients (43).…”

“…In contrast, morphologic analysis of the capillary loops of the nonaffected toes and fingers showed no significant differences from those of normal controls (42,43). The parameters for the cutaneous microcirculation including resting capillary blood cell velocity, peak capillary blood cell velocity, and time to peak capillary blood cell velocity were significantly disturbed in both the affected and nonaffected toes and fingers in the blackfoot disease patients (43). Deficits in cutaneous microcirculation of the toes were demonstrated among clinically normal subjects living in the blackfoot disease endemic area (44).…”